Provider Demographics
NPI:1659389849
Name:SUNRISE COMMUNITY OF VIRGINIA, INC.
Entity Type:Organization
Organization Name:SUNRISE COMMUNITY OF VIRGINIA, INC.
Other - Org Name:RIVA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-273-3011
Mailing Address - Street 1:9040 SW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3432
Mailing Address - Country:US
Mailing Address - Phone:305-596-9040
Mailing Address - Fax:305-598-8240
Practice Address - Street 1:4085 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4106
Practice Address - Country:US
Practice Address - Phone:703-359-4430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004947711OtherPROVIDER