Provider Demographics
NPI:1194521682
Name:7501 SUNRISE BLVD LLC
Entity type:Organization
Organization Name:7501 SUNRISE BLVD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-441-0123
Mailing Address - Street 1:650 HOWE AVE BLDG 400-A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4731
Mailing Address - Country:US
Mailing Address - Phone:916-441-0123
Mailing Address - Fax:
Practice Address - Street 1:7501 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-3059
Practice Address - Country:US
Practice Address - Phone:916-441-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TLCS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health