Provider Demographics
NPI:1821003310
Name:SUNRISE ENTERPRISE LLC
Entity Type:Organization
Organization Name:SUNRISE ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONTA
Authorized Official - Middle Name:CITA
Authorized Official - Last Name:SAXON
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:319-385-2019
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:MORNING SUN
Mailing Address - State:IA
Mailing Address - Zip Code:52640-0244
Mailing Address - Country:US
Mailing Address - Phone:319-385-2910
Mailing Address - Fax:319-385-2913
Practice Address - Street 1:1405 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2875
Practice Address - Country:US
Practice Address - Phone:319-385-2910
Practice Address - Fax:319-385-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI18644Medicare PIN