Provider Demographics
NPI:1417985524
Name:SUNRISE COUNTY HOMECARE SERVICES, INC.
Entity Type:Organization
Organization Name:SUNRISE COUNTY HOMECARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-733-1090
Mailing Address - Street 1:43 S LUBEC RD
Mailing Address - Street 2:
Mailing Address - City:LUBEC
Mailing Address - State:ME
Mailing Address - Zip Code:04652-3620
Mailing Address - Country:US
Mailing Address - Phone:207-733-7500
Mailing Address - Fax:207-733-7555
Practice Address - Street 1:43 S LUBEC RD
Practice Address - Street 2:
Practice Address - City:LUBEC
Practice Address - State:ME
Practice Address - Zip Code:04652-3620
Practice Address - Country:US
Practice Address - Phone:207-733-7500
Practice Address - Fax:207-733-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2740251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME130440000Medicaid
ME130440000Medicaid