Provider Demographics
NPI:1497226047
Name:SUNRISE CARE HOME LLC
Entity Type:Organization
Organization Name:SUNRISE CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:TAYAG
Authorized Official - Suffix:
Authorized Official - Credentials:RCFE ADMINISTRATOR
Authorized Official - Phone:510-481-1300
Mailing Address - Street 1:1447 VIA LUCAS
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580
Mailing Address - Country:US
Mailing Address - Phone:510-481-1300
Mailing Address - Fax:510-276-5888
Practice Address - Street 1:1447 VIA LUCAS
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580
Practice Address - Country:US
Practice Address - Phone:510-481-1300
Practice Address - Fax:510-276-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health