Provider Demographics
NPI:1285932319
Name:SONRISAS THERAPIES- PEDIATRIC HOME AND HEALTHCARE SERVICES, LLC.
Entity type:Organization
Organization Name:SONRISAS THERAPIES- PEDIATRIC HOME AND HEALTHCARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TSAMBIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKIRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:512-900-7934
Mailing Address - Street 1:2100 E MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-1342
Mailing Address - Country:US
Mailing Address - Phone:512-900-7934
Mailing Address - Fax:512-900-7954
Practice Address - Street 1:2100 E MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-1342
Practice Address - Country:US
Practice Address - Phone:512-900-7934
Practice Address - Fax:512-900-7954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014142251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2829814-01Medicaid