Healthcare Provider Details

I. General information

NPI: 1982345377
Provider Name (Legal Business Name): SUNRISE AT PARWKAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 INTERSTATE PKWY
AUGUSTA GA
30909-5626
US

IV. Provider business mailing address

1339 INTERSTATE PKWY
AUGUSTA GA
30909-5626
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-8817
  • Fax: 706-868-8878
Mailing address:
  • Phone: 706-868-8817
  • Fax: 706-868-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MATOS
Title or Position: OWNER
Credential:
Phone: 706-945-5582