Provider Demographics
NPI:1588025464
Name:SUNRISE BEHAVIORAL HEALTH AND SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:SUNRISE BEHAVIORAL HEALTH AND SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-400-4845
Mailing Address - Street 1:11077 BISCAYNE BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7568
Mailing Address - Country:US
Mailing Address - Phone:305-400-4845
Mailing Address - Fax:305-400-4845
Practice Address - Street 1:100 NE 15TH ST STE 205
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4577
Practice Address - Country:US
Practice Address - Phone:305-400-4845
Practice Address - Fax:305-400-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024218900Medicaid