| Sun-rise Living Behavior Health Services, Llc | |
|
943 Cesery Blvd Ste G Jacksonville FL 32211-5655 | |
| (904) 745-0067 | |
| Not Available |
| Full Name | Sun-rise Living Behavior Health Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 943 Cesery Blvd Ste G, Jacksonville, Florida |
| Authorized Official Name and Position | Miguel Moreno Colon (OWNER) |
| Authorized Official Contact | 9047450067 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sun-rise Living Behavior Health Services, Llc 943 Cesery Blvd Ste G Jacksonville FL 32211-5655 Ph: (904) 745-0067 | Sun-rise Living Behavior Health Services, Llc 943 Cesery Blvd Ste G Jacksonville FL 32211-5655 Ph: (904) 745-0067 |
| NPI Number | 1073910931 |
|---|---|
| Provider Enumeration Date | 11/20/2014 |
| Last Update Date | 02/27/2017 |
| Medicare PECOS PAC ID | 2769747047 |
|---|---|
| Medicare Enrollment ID | O20180607002999 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073910931 | NPI | - | NPPES |
| Provider Name | Raul Soto-acosta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619991106 PECOS PAC ID: 5799727228 Enrollment ID: I20050525000572 |
| Provider Name | Rosa Daisy Maytin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972068708 PECOS PAC ID: 7416298872 Enrollment ID: I20190411001984 |
| Provider Name | Latasha Yvette Mcclellan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871101691 PECOS PAC ID: 5597144568 Enrollment ID: I20220622000574 |
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