Provider Demographics
NPI:1629561592
Name:SUNRISE HOSPICE, INC.
Entity Type:Organization
Organization Name:SUNRISE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:MORENO
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-239-7802
Mailing Address - Street 1:4402 VANCE JACKSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5354
Mailing Address - Country:US
Mailing Address - Phone:210-239-7802
Mailing Address - Fax:210-817-8614
Practice Address - Street 1:4402 VANCE JACKSON RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5354
Practice Address - Country:US
Practice Address - Phone:210-239-7802
Practice Address - Fax:210-817-8614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based