Basic Information
| Provider Information | |||||||||
| NPI: | 1497891691 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUNRISE COMMUNITY, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUNRISE COMMUNITY, INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22300 SW 162ND AVE | ||||||||
| Address2: | |||||||||
| City: | GOULDS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331703907 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 22300 SW 162ND AVE | ||||||||
| Address2: | |||||||||
| City: | GOULDS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331703907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052456150 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WEEKS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BOARD SECRETARY & TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 3052733024 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 315P00000X | Y | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mentally Retarded |
No ID Information.