Healthcare Provider Details

I. General information

NPI: 1790585784
Provider Name (Legal Business Name): SUNRISE PROMISE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 33RD AVE SW
CEDAR RAPIDS IA
52404-4646
US

IV. Provider business mailing address

260 33RD AVE SW
CEDAR RAPIDS IA
52404-4646
US

V. Phone/Fax

Practice location:
  • Phone: 319-560-5523
  • Fax:
Mailing address:
  • Phone: 319-560-5523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DAWN RICHARD
Title or Position: OWNER
Credential: LLMC
Phone: 319-830-5526