Provider Demographics
NPI:1093311284
Name:SUN PEAK HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUN PEAK HEALTHCARE LLC
Other - Org Name:SACRED HEART HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:4400 E BROADWAY BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3517
Mailing Address - Country:US
Mailing Address - Phone:520-577-4630
Mailing Address - Fax:
Practice Address - Street 1:4400 E BROADWAY BLVD STE 405
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3517
Practice Address - Country:US
Practice Address - Phone:520-577-4630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health