Basic Information
| Provider Information | |||||||||
| NPI: | 1740513761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNRISE COMMUNITY INC, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9040 SUNSET DR | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331733432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055939040 | ||||||||
| FaxNumber: | 3055988240 | ||||||||
| Practice Location | |||||||||
| Address1: | 4745 NW 7TH CT | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334269340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055969040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2009 | ||||||||
| LastUpdateDate: | 09/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | WEEKS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | BOARD SECRETARY/C.F.O. | ||||||||
| AuthorizedOfficialTelephone: | 3052733024 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 024975111 | 05 | FL | MEDICAID |