Organization
SUNRISE DETOX MILLBURY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH M CHELALES (ADMINISTRATOR)
(646) 285-4035
Entity
Organization
Contact information
Practice address
29 MAIN ST, MILLBURY, MA 01527-2005
(508) 581-5225
(508) 865-2823
Mailing address
PO BOX 12586, NEWARK, NJ 07101-3562
(508) 581-5225
(508) 865-2823
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XX-XXX9587
TIN
MA
Enumeration date
08/30/2018
Last updated
10/11/2023
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