Provider Demographics
NPI:1982771820
Name:SUNRISE COMMUNITY, INC.
Entity Type:Organization
Organization Name:SUNRISE COMMUNITY, INC.
Other - Org Name:ST. PETERSBURG CLUSTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:KARINA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-273-3047
Mailing Address - Street 1:1101-102ND AVE, NORTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-2803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101-102ND AVE, NORTH
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-2803
Practice Address - Country:US
Practice Address - Phone:727-576-0492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU028018601Medicaid