Provider Demographics
NPI:1437451804
Name:SUNRISE SUPPLY LLC
Entity Type:Organization
Organization Name:SUNRISE SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUMES
Authorized Official - Suffix:
Authorized Official - Credentials:PAUL D HUMES
Authorized Official - Phone:414-380-4476
Mailing Address - Street 1:5308 W. GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214
Mailing Address - Country:US
Mailing Address - Phone:414-384-8554
Mailing Address - Fax:414-264-8119
Practice Address - Street 1:5308 W. GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-384-8554
Practice Address - Fax:414-264-8119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE SUPPLY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies