Provider Demographics
NPI:1942787189
Name:SUNRISE CONSULTANT SERVICES, INC
Entity Type:Organization
Organization Name:SUNRISE CONSULTANT SERVICES, INC
Other - Org Name:SUNRISE CLINICAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MSN, RN
Authorized Official - Prefix:
Authorized Official - First Name:YVETTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:YVETTA L MASSEY
Authorized Official - Phone:708-880-1397
Mailing Address - Street 1:502 W 138TH STREET
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60827
Mailing Address - Country:US
Mailing Address - Phone:312-778-4258
Mailing Address - Fax:708-880-1239
Practice Address - Street 1:502 W 138TH STREET
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:IL
Practice Address - Zip Code:60827-6082
Practice Address - Country:US
Practice Address - Phone:312-778-4258
Practice Address - Fax:708-880-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041265569261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12141960OtherFAMILY MEDICINE