Provider Demographics
NPI:1164662052
Name:SUNRISE HEALTH CARE, PC
Entity Type:Organization
Organization Name:SUNRISE HEALTH CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:N
Authorized Official - Last Name:NWEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-577-9977
Mailing Address - Street 1:4020 PALMER PARK BLVD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3433
Mailing Address - Country:US
Mailing Address - Phone:719-577-9977
Mailing Address - Fax:719-577-9911
Practice Address - Street 1:4020 PALMER PARK BLVD
Practice Address - Street 2:SUITE 101B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3433
Practice Address - Country:US
Practice Address - Phone:719-577-9977
Practice Address - Fax:719-577-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CO34753207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74575724Medicaid