Provider Demographics
NPI:1508084724
Name:SUNRISE CENTER HEALTHCARE, LLC.
Entity Type:Organization
Organization Name:SUNRISE CENTER HEALTHCARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARICELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-874-8053
Mailing Address - Street 1:955 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5261
Mailing Address - Country:US
Mailing Address - Phone:419-874-8053
Mailing Address - Fax:419-874-8053
Practice Address - Street 1:955 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5261
Practice Address - Country:US
Practice Address - Phone:419-874-8053
Practice Address - Fax:419-874-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0171880OtherWAIVER