MEDICARE: SUNRISE ABA & AUTISM SERVICES, L.L.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548811177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE ABA & AUTISM SERVICES, L.L.C

Provider Business Mailing Address
First Line	:	5202 OLDE FOREST DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-8763
Country	:	US
Telephone Number	:	336-455-1517
Fax Number	:	336-645-7051

Provider Business Practice Location Address
First Line	:	4160 PIEDMONT PKWY STE 205
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8174
Country	:	US
Telephone Number	:	336-645-6733
Fax Number	:	336-645-7051

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	MS. MAMIE ANN TURNER
Credential	:	BCBA
Telephone Number	:	336-455-1517

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	08/24/2020

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