Organization
SUNRISE COMMUNITY OF TENNESSEE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN DAVIDSON MACC (SECRETARY/TREASURER/CFO)
(305) 273-3023
Entity
Organization
Contact information
Practice address
640 OLD SHILOH RD, GREENEVILLE, TN 37745-0556
(423) 329-3973
Mailing address
9040 SUNSET DR, MIAMI, FL 33173-3432
(305) 596-9040
(305) 275-3345
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
L000000015489
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L000000015489
STATE OF TENNESSEE DEPARTMENT OF INTELLECTUAL & DEVELOPMENTAL DISABILITIES
TN
Enumeration date
05/04/2017
Last updated
05/04/2017
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