Provider Demographics
NPI:1558319236
Name:SUNRISE HOME HEALTH SERVICES OF AMERICA, INC.
Entity Type:Organization
Organization Name:SUNRISE HOME HEALTH SERVICES OF AMERICA, INC.
Other - Org Name:SUNRISE HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-278-1414
Mailing Address - Street 1:PO BOX 494728
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75049-4728
Mailing Address - Country:US
Mailing Address - Phone:972-278-1414
Mailing Address - Fax:972-278-1413
Practice Address - Street 1:1221 ARISTA DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6657
Practice Address - Country:US
Practice Address - Phone:972-278-1414
Practice Address - Fax:972-278-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001939251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024513601Medicaid
677158Medicare Oscar/Certification