NPIMap

Organization Active NPI

Bamboo Sunrise LLC

  • Community/Behavioral Health Agency
  • Henderson, NV
National Provider Identifier
1942577994
Registry record updated Sep 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BAMBOO SUNRISE LLC
Practice address
98 E Lake Mead Pkwy Ste 201
Henderson, NV 89015-6443
Phone
(702) 433-3038
NPI assigned
Nov 18, 2011
Last updated
Sep 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shirley Lim HoldemanNPI 1225331853
Title
Chief Executive Officer
Phone
(702) 433-3038

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Group Psychotherapy Psychologist 103TP2701X
Rehabilitation Psychologist 103TR0400X
Child & Adolescent Psychiatric/Mental Health Registered Nurse 163WP0807X
Psychiatric/Mental Health Registered Nurse 163WP0808X
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

98 E Lake Mead Pkwy Ste 201
Henderson, NV 89015-6443

Mailing address

98 E Lake Mead Pkwy Ste 201
Henderson, NV 89015-6443
Phone (702) 433-3038

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251009000230 NV Part B Supplier - Clinic/Group Practice 8921505579 Receives reassigned benefits from 1 practitioner
Practice locations: Henderson, NV

National Provider Directory

National Provider Directory
Tax ID family
Bamboo Sunrise LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1942577994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 E LAKE MEAD PKWY STE 201",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890156443",
            "telephone_number": "702-433-3038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 E LAKE MEAD PKWY STE 201",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890156443",
            "telephone_number": "702-433-3038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAMBOO SUNRISE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-18",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A",
        "authorized_official_last_name": "HOLDEMAN",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "LIM",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "702-433-3038"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.