Provider Demographics
NPI:1083497101
Name:SUNRISE CLINICS
Entity Type:Organization
Organization Name:SUNRISE CLINICS
Other - Org Name:SUNRISE CLINICS - WLV LOUIS ARMIJO SBHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-472-4311
Mailing Address - Street 1:117 CAMINO DE VIDA STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:NM
Mailing Address - Zip Code:88435-2267
Mailing Address - Country:US
Mailing Address - Phone:575-472-4311
Mailing Address - Fax:877-553-1272
Practice Address - Street 1:412 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3488
Practice Address - Country:US
Practice Address - Phone:505-426-2599
Practice Address - Fax:877-553-1272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-14
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM93778562Medicaid