MEDICARE: SUNRISE OUTREACH SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1255841326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE OUTREACH SERVICES

Provider Business Mailing Address
First Line	:	304 E PINE ST # 89
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4969
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 E PINE ST # 89
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4969
Country	:	US
Telephone Number	:	702-818-9114
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFANY LILES
Credential	:
Telephone Number	:	702-818-9114

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	10/03/2017

Similar Medicare Providers

1437312451 — KEVIN MARK SHELTON
Practice Location Address:

322 E PINE ST
LAKELAND, FL
33801-4969

Practice Phone: 863-603-7827
Practice Fax: 863-603-0255

1720374358 — SHELTON TECHNOLOGIES AND RESOURCES LLC
Practice Location Address:

322 E PINE ST
LAKELAND, FL
33801-4969

Practice Phone: 863-603-7827
Practice Fax: 863-603-0255

1124531769 — KEISHLA M TORRES-MALDONADO BCBA
Practice Location Address:

304 E PINE ST # 1252
LAKELAND, FL
33801-4969

Practice Phone: 813-602-0068
Practice Fax: 813-354-2715

1659858686 — SUSAN EMILY KENNEDY
Practice Location Address:

304 E PINE ST # 19
LAKELAND, FL
33801-4969

Practice Phone: 863-614-0048
Practice Fax: 863-279-1204

1326500067 — AMANDA M DEAL
Practice Location Address:

304 E PINE ST # 1252
LAKELAND, FL
33801-4969

Practice Phone: 813-602-0068
Practice Fax:

1912569187 — GENE MARTIN WIGGS II DO
Practice Location Address:

304 E PINE ST # 5280
LAKELAND, FL
33801-4969

Practice Phone: 863-248-2300
Practice Fax:

Directions to “SUNRISE OUTREACH SERVICES ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.