Provider Demographics
NPI:1003221599
Name:SUNRISE NURSING CARE CENTER, LLC
Entity Type:Organization
Organization Name:SUNRISE NURSING CARE CENTER, LLC
Other - Org Name:SUNRISE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ARYEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-793-0167
Mailing Address - Street 1:50 BRIGGS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1267
Mailing Address - Country:US
Mailing Address - Phone:773-793-0167
Mailing Address - Fax:773-913-0386
Practice Address - Street 1:50 BRIGGS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1267
Practice Address - Country:US
Practice Address - Phone:210-921-0184
Practice Address - Fax:210-927-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001026173Medicaid
TX455713Medicare Oscar/Certification