Provider Demographics
NPI:1134310139
Name:SUN BROOK HOME CARE LLC
Entity Type:Organization
Organization Name:SUN BROOK HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY AND GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-664-2876
Mailing Address - Street 1:491 WILLIAMSON ROAD,
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9252
Mailing Address - Country:US
Mailing Address - Phone:704-664-2876
Mailing Address - Fax:
Practice Address - Street 1:5801 FASHION BLVD.
Practice Address - Street 2:SUITE 290
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-6156
Practice Address - Country:US
Practice Address - Phone:801-254-5722
Practice Address - Fax:801-446-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health