| New Sunrise Community Behavioral Llc | |
|
17670 Nw 78th Ave Ste 113 Hialeah FL 33015-3665 | |
| (786) 558-4565 | |
| (305) 995-0927 |
| Full Name | New Sunrise Community Behavioral Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 17670 Nw 78th Ave Ste 113, Hialeah, Florida |
| Authorized Official Name and Position | Rosirenee Quesada (PRESIDENT) |
| Authorized Official Contact | 7867153086 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Sunrise Community Behavioral Llc 17670 Nw 78th Ave Ste 113 Hialeah FL 33015-3665 Ph: (786) 558-4565 | New Sunrise Community Behavioral Llc 17670 Nw 78th Ave Ste 113 Hialeah FL 33015-3665 Ph: (786) 558-4565 |
| NPI Number | 1851047856 |
|---|---|
| Provider Enumeration Date | 02/28/2022 |
| Last Update Date | 04/29/2025 |
| Certification Date | 04/29/2025 |
| Medicare PECOS PAC ID | 9032577911 |
|---|---|
| Medicare Enrollment ID | O20230626000685 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851047856 | NPI | - | NPPES |
| 113524800 | Medicaid | FL | |
| 124899600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Carlos A Ripoll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558751099 PECOS PAC ID: 7214034404 Enrollment ID: I20151014001048 |
| Provider Name | Melida Berroa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275165367 PECOS PAC ID: 9638591993 Enrollment ID: I20200616000767 |
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