Provider Demographics
NPI:1629354535
Name:SUNRISE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:SUNRISE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLACE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:567-712-6304
Mailing Address - Street 1:2626 SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1412
Mailing Address - Country:US
Mailing Address - Phone:567-712-6304
Mailing Address - Fax:567-712-6298
Practice Address - Street 1:2626 SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-1412
Practice Address - Country:US
Practice Address - Phone:567-712-6304
Practice Address - Fax:567-712-6298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN274524251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0090959Medicaid