Provider Demographics
NPI:1073282117
Name:SUNRISE FOR A HAPPY LIFE ADC
Entity Type:Organization
Organization Name:SUNRISE FOR A HAPPY LIFE ADC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:I
Authorized Official - Last Name:PONGUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-272-3852
Mailing Address - Street 1:410 W HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1418
Mailing Address - Country:US
Mailing Address - Phone:863-272-3852
Mailing Address - Fax:863-337-6638
Practice Address - Street 1:833 N LAKE PARKER AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-2044
Practice Address - Country:US
Practice Address - Phone:863-614-6136
Practice Address - Fax:863-337-6638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care