Provider Demographics
NPI:1942668900
Name:SUNRISE MEDICAL & COMMUNITY MENTAL HEALTH CENTER CORP
Entity Type:Organization
Organization Name:SUNRISE MEDICAL & COMMUNITY MENTAL HEALTH CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATACHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-217-5427
Mailing Address - Street 1:100 NW 82ND AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1835
Mailing Address - Country:US
Mailing Address - Phone:786-217-5427
Mailing Address - Fax:786-615-7059
Practice Address - Street 1:100 NW 82ND AVE STE 402
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1835
Practice Address - Country:US
Practice Address - Phone:786-217-5427
Practice Address - Fax:786-615-7059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty