Provider Demographics
NPI:1619174182
Name:SUNRISE IN-HOME CARE
Entity Type:Organization
Organization Name:SUNRISE IN-HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-659-6393
Mailing Address - Street 1:29 W HENDERSON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4505
Mailing Address - Country:US
Mailing Address - Phone:828-659-6393
Mailing Address - Fax:828-659-3437
Practice Address - Street 1:29 W HENDERSON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4505
Practice Address - Country:US
Practice Address - Phone:828-659-6393
Practice Address - Fax:828-659-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2204251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601460Medicaid