Provider Demographics
NPI:1689228520
Name:SUNRISE MOUNTAIN HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUNRISE MOUNTAIN HEALTHCARE LLC
Other - Org Name:RIO VISTA POST ACUTE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:10323 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7345
Mailing Address - Country:US
Mailing Address - Phone:623-875-0100
Mailing Address - Fax:623-875-0110
Practice Address - Street 1:10323 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7345
Practice Address - Country:US
Practice Address - Phone:623-875-0100
Practice Address - Fax:623-875-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)