Provider Demographics
NPI:1518160381
Name:SUNRISE HOME HEALTH SERVICES OF NEW MEXICO,LLC
Entity Type:Organization
Organization Name:SUNRISE HOME HEALTH SERVICES OF NEW MEXICO,LLC
Other - Org Name:VISTA ENTERPRISES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:M
Authorized Official - Last Name:GURULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-426-4380
Mailing Address - Street 1:PO BOX 1345
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-1345
Mailing Address - Country:US
Mailing Address - Phone:505-426-4380
Mailing Address - Fax:505-426-8688
Practice Address - Street 1:932 GALLINAS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3891
Practice Address - Country:US
Practice Address - Phone:505-426-4380
Practice Address - Fax:505-426-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1934251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion