Healthcare Provider Details

I. General information

NPI: 1588025464
Provider Name (Legal Business Name): SUNRISE BEHAVIORAL HEALTH AND SUPPORT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NE 15TH ST STE 205
HOMESTEAD FL
33030-4577
US

IV. Provider business mailing address

11077 BISCAYNE BLVD STE 410
MIAMI FL
33161-7568
US

V. Phone/Fax

Practice location:
  • Phone: 305-400-4845
  • Fax: 305-400-4845
Mailing address:
  • Phone: 305-400-4845
  • Fax: 305-400-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: TAMARA ROSARIO
Title or Position: CEO/PRESIDENT/DIRECTOR
Credential: LMHC
Phone: 305-400-4845