MEDICARE: SUNRISE FOR A HAPPY LIFE ADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073282117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE FOR A HAPPY LIFE ADC

Provider Business Mailing Address
First Line	:	410 W HANCOCK ST
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-1418
Country	:	US
Telephone Number	:	863-272-3852
Fax Number	:	863-337-6638

Provider Business Practice Location Address
First Line	:	833 N LAKE PARKER AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-2044
Country	:	US
Telephone Number	:	863-614-6136
Fax Number	:	863-337-6638

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARTHA I PONGUTA
Credential	:
Telephone Number	:	863-272-3852

Provider Enumeration Date	:	09/11/2021
Last Update Date	:	09/11/2021

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Directions to “SUNRISE FOR A HAPPY LIFE ADC ” Practice Location

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