Provider Demographics
NPI:1720021033
Name:SUNCREST HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SUNCREST HEALTHCARE, LLC
Other - Org Name:SUNCREST HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-587-4505
Mailing Address - Street 1:608 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5003
Mailing Address - Country:US
Mailing Address - Phone:615-865-9841
Mailing Address - Fax:615-860-6392
Practice Address - Street 1:608 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5003
Practice Address - Country:US
Practice Address - Phone:615-865-9841
Practice Address - Fax:615-860-6392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
447402Medicare ID - Type UnspecifiedHOME HEALTH