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General NPI Number Information
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NPI Number | 1073282117
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Entity Type | Organization
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Legal Business Name | SUNRISE FOR A HAPPY LIFE ADC
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Dates
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Enumeration Date | 09/11/2021
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Last Update Date | 09/11/2021
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Provider Practice Location Address
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Address Line | 833 N LAKE PARKER AVE
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City | LAKELAND
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State | FL
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Zip | 33801-2044
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Country | US
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Telephone | 863-614-6136
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Fax | 863-337-6638
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Provider Business Mailing Address
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Address Line | 410 W HANCOCK ST
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City | LAKELAND
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State | FL
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Zip | 33803-1418
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Country | US
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Telephone | 863-272-3852
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Fax | 863-337-6638
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARTHA I PONGUTA
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Credential |
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Telephone | 863-272-3852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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