Provider Demographics
NPI:1902005382
Name:SUNRISE COMMUNITY HEALTH
Entity Type:Organization
Organization Name:SUNRISE COMMUNITY HEALTH
Other - Org Name:LOVELAND COMMUNITY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-346-2546
Mailing Address - Street 1:2930 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 3RD ST SE STE 150
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-6419
Practice Address - Country:US
Practice Address - Phone:970-669-4855
Practice Address - Fax:970-669-7389
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE COMMUNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-16
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CO261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05638895Medicaid
COE9418Medicare UPIN
C2908Medicare PIN
CO05638895Medicaid