Provider Demographics
NPI:1770325029
Name:SUNRISE THERAPEUTIC SERVICES OF VA, LLC
Entity type:Organization
Organization Name:SUNRISE THERAPEUTIC SERVICES OF VA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:SPAHR
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MED, BCBA, LBA
Authorized Official - Phone:540-312-8814
Mailing Address - Street 1:513 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRACEY
Mailing Address - State:VA
Mailing Address - Zip Code:23919-1630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:219 E ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2003
Practice Address - Country:US
Practice Address - Phone:540-312-8814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty