Healthcare Provider Details

I. General information

NPI: 1164314993
Provider Name (Legal Business Name): SUNRISE ABA OF COLORADO,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8332 YARROW CT
ARVADA CO
80005-2532
US

IV. Provider business mailing address

1530 MERIDIAN AVE
SAN JOSE CA
95125-5350
US

V. Phone/Fax

Practice location:
  • Phone: 628-250-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRADY KEITH
Title or Position: CEO
Credential:
Phone: 707-799-9527