Provider Demographics
NPI:1982857686
Name:SUNRISE THERAPY & SUPPORT SERVICES
Entity Type:Organization
Organization Name:SUNRISE THERAPY & SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-915-0122
Mailing Address - Street 1:PO BOX 3265
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-6265
Mailing Address - Country:US
Mailing Address - Phone:252-915-0122
Mailing Address - Fax:919-529-2096
Practice Address - Street 1:911 LINDEN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3683
Practice Address - Country:US
Practice Address - Phone:252-915-0122
Practice Address - Fax:919-529-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006590Medicaid