Healthcare Provider Details

I. General information

NPI: 1548811177
Provider Name (Legal Business Name): SUNRISE ABA & AUTISM SERVICES, L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 PIEDMONT PKWY STE 205
GREENSBORO NC
27410-8174
US

IV. Provider business mailing address

5202 OLDE FOREST DR
GREENSBORO NC
27406-8763
US

V. Phone/Fax

Practice location:
  • Phone: 336-645-6733
  • Fax: 336-645-7051
Mailing address:
  • Phone: 336-455-1517
  • Fax: 336-645-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MAMIE ANN TURNER
Title or Position: BEHAVIOR ANALYST
Credential: BCBA
Phone: 336-455-1517