Provider Demographics
NPI:1700013885
Name:SONRISA HOME CARE LLC
Entity Type:Organization
Organization Name:SONRISA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RIPPISTINE
Authorized Official - Suffix:III
Authorized Official - Credentials:RN
Authorized Official - Phone:956-412-1870
Mailing Address - Street 1:PO BOX 1052
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:TX
Mailing Address - Zip Code:78593-1052
Mailing Address - Country:US
Mailing Address - Phone:956-412-1870
Mailing Address - Fax:956-412-0773
Practice Address - Street 1:216 S 10TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:TX
Practice Address - Zip Code:78593-2473
Practice Address - Country:US
Practice Address - Phone:956-412-1870
Practice Address - Fax:956-412-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013481251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-7779OtherMEDICARE PTAN
TX747779OtherMEDICARE ID#
TX3381550Medicaid
TX518637OtherJOINT COMMISSION ID