1316031131 NPI number — SUNRISE RELAX HEALTH CARE CORP.

Table of content: (NPI 1316031131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316031131 NPI number — SUNRISE RELAX HEALTH CARE CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNRISE RELAX HEALTH CARE CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316031131
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
636 SW 109TH AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWEETWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33174-1338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-221-8500
Provider Business Mailing Address Fax Number:
305-221-8501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
636 SW 109TH AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWEETWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33174-1338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-221-8500
Provider Business Practice Location Address Fax Number:
305-221-8501
Provider Enumeration Date:
10/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FAJO
Authorized Official First Name:
WILFREDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-316-5546

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTA-14895 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: MA-38546 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3747P1801X , with the licence number: CNA-68343 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)