Provider Demographics
NPI:1043937576
Name:SUNRISE COMMUNITY HEALTH
Entity Type:Organization
Organization Name:SUNRISE COMMUNITY HEALTH
Other - Org Name:SUNRISE THOMPSON DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-346-2546
Mailing Address - Street 1:2930 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-1011
Mailing Address - Country:US
Mailing Address - Phone:970-613-6800
Mailing Address - Fax:970-613-6801
Practice Address - Street 1:2880 MONROE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3274
Practice Address - Country:US
Practice Address - Phone:970-613-6800
Practice Address - Fax:970-613-6801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE COMMUNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-25
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty