Provider Demographics
NPI:1134804099
Name:SUNRISE HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:SUNRISE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CHARLIE
Authorized Official - Suffix:
Authorized Official - Credentials:NCPT
Authorized Official - Phone:505-330-6953
Mailing Address - Street 1:1305 HUTTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-7601
Mailing Address - Country:US
Mailing Address - Phone:505-330-6953
Mailing Address - Fax:
Practice Address - Street 1:1305 HUTTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-7601
Practice Address - Country:US
Practice Address - Phone:505-330-6953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty