Provider Demographics
NPI:1790537934
Name:SUNRISE ABA THERAPY LLC
Entity Type:Organization
Organization Name:SUNRISE ABA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:786-805-7588
Mailing Address - Street 1:1323 PEPPERTREE TRL APT A
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-5252
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1323 PEPPERTREE TRL APT A
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-5252
Practice Address - Country:US
Practice Address - Phone:786-805-7588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty