Provider Demographics
NPI:1548811177
Name:SUNRISE ABA & AUTISM SERVICES, L.L.C
Entity type:Organization
Organization Name:SUNRISE ABA & AUTISM SERVICES, L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:MAMIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:336-455-1517
Mailing Address - Street 1:5202 OLDE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8763
Mailing Address - Country:US
Mailing Address - Phone:336-455-1517
Mailing Address - Fax:336-645-7051
Practice Address - Street 1:4160 PIEDMONT PKWY STE 205
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8174
Practice Address - Country:US
Practice Address - Phone:336-645-6733
Practice Address - Fax:336-645-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1548811177Medicaid