Provider Demographics
NPI:1992854772
Name:SUNRISE MEDICAL TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:SUNRISE MEDICAL TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-899-1440
Mailing Address - Street 1:9375 ARCHIBALD AVE
Mailing Address - Street 2:SUITE #210
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5729
Mailing Address - Country:US
Mailing Address - Phone:909-899-1440
Mailing Address - Fax:909-527-4596
Practice Address - Street 1:9375 ARCHIBALD AVE
Practice Address - Street 2:SUITE #210
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5729
Practice Address - Country:US
Practice Address - Phone:909-899-1440
Practice Address - Fax:909-527-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN00797FMedicaid