Healthcare Provider Details

I. General information

NPI: 1164045290
Provider Name (Legal Business Name): SUNRISE SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 RUBY AVE STE 201
KISSIMMEE FL
34741-5627
US

IV. Provider business mailing address

241 RUBY AVE STE 201
KISSIMMEE FL
34741-5627
US

V. Phone/Fax

Practice location:
  • Phone: 407-205-8103
  • Fax: 321-900-0611
Mailing address:
  • Phone: 407-205-8103
  • Fax: 321-900-0611

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: MRS. TAMARA A ROSARIO
Title or Position: OWNER
Credential: LMHC
Phone: 407-205-8103