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General NPI Number Information
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NPI Number | 1588093322
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Entity Type | Organization
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Legal Business Name | SUNRISE HOME CARE SERVICES, LLC
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/02/2013
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Provider Practice Location Address
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Address Line | 9926 PROSPECT AVE
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City | HAMPTON
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State | FL
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Zip | 32044-4411
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Country | US
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Telephone | 352-468-2619
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 213
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City | HAMPTON
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State | FL
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Zip | 32044-0213
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Country | US
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Telephone | 352-468-2619
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR / MANAGER
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Name | REYNALDO YOUNG
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Credential |
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Telephone | 352-468-2619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AL5084
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License Number State | FL
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