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NPI Code Detail

MEDICARE: SUNRISE COMMUNITY OF TENNESSEE, INC.

MEDICARE: SUNRISE COMMUNITY OF TENNESSEE, INC.
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
1251C00000XDevelopmentally Disabled Services Day Training Agency

General Provider Information

NPI Number : 1093091274
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNRISE COMMUNITY OF TENNESSEE, INC.
Provider Business Mailing Address
First Line : 9040 SUNSET DR
Second Line :
City : MIAMI
State : FL
Zip : 33173-3432
Country : US
Telephone Number : 305-593-9040
Fax Number :
Provider Business Practice Location Address
First Line : 5645 MERCHANTS CENTER BLVD
Second Line :
City : KNOXVILLE
State : TN
Zip : 37912-3470
Country : US
Telephone Number : 931-648-3011
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : DR. JAMES WEEKS
Credential : PH. D
Telephone Number : 305-273-3024
Provider Enumeration Date : 11/01/2011
Last Update Date : 11/01/2011

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