Provider Demographics
NPI:1205242989
Name:SUNRISE ADULT CARE INC
Entity type:Organization
Organization Name:SUNRISE ADULT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANNAH
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:561-723-0671
Mailing Address - Street 1:4102 COOLEY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4312
Mailing Address - Country:US
Mailing Address - Phone:561-967-2287
Mailing Address - Fax:561-249-1394
Practice Address - Street 1:4102 COOLEY CT
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4312
Practice Address - Country:US
Practice Address - Phone:561-967-2287
Practice Address - Fax:561-249-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8286310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012434900Medicaid