Provider Demographics
NPI:1295137487
Name:SUNRISE WELLNESS CENTER LLC
Entity type:Organization
Organization Name:SUNRISE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KROP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-219-7212
Mailing Address - Street 1:777 SHOTGUN RD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1940
Mailing Address - Country:US
Mailing Address - Phone:800-219-7212
Mailing Address - Fax:800-219-7213
Practice Address - Street 1:777 SHOTGUN RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-1940
Practice Address - Country:US
Practice Address - Phone:800-219-7212
Practice Address - Fax:800-219-7213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty