Organization
SUNRISE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORNELL SMITH (ADMINISTRATOR)
(832) 554-6595
Entity
Organization
Contact information
Practice address
4560 S EASTERN AVE, SUITE B17, LAS VEGAS, NV 89119-6182
(832) 554-6595
Mailing address
4560 S EASTERN AVE, SUITE B17, LAS VEGAS, NV 89119-6182
(832) 554-6595
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
02/24/2015
Last updated
02/24/2015
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