MEDICARE: SUNRISE COMMUNITY, 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
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

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	:	1497891691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE COMMUNITY, INC.

Provider Business Mailing Address
First Line	:	22300 SW 162ND AVE
Second Line	:
City	:	GOULDS
State	:	FL
Zip	:	33170-3907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22300 SW 162ND AVE
Second Line	:
City	:	GOULDS
State	:	FL
Zip	:	33170-3907
Country	:	US
Telephone Number	:	305-245-6150
Fax Number	:

Authorized Official
Title or Position	:	BOARD SECRETARY & TREASURER
Name	:	DR. JAMES WEEKS
Credential	:
Telephone Number	:	305-273-3024

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/22/2020

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Directions to “SUNRISE COMMUNITY, INC. ” Practice Location

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