Provider Demographics
NPI:1245851799
Name:SUNRISE HEALING ARTS LLC
Entity type:Organization
Organization Name:SUNRISE HEALING ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:IONE
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:426-891-0332
Mailing Address - Street 1:625 HWY 101 PMB 329
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439
Mailing Address - Country:US
Mailing Address - Phone:425-891-0332
Mailing Address - Fax:
Practice Address - Street 1:1845 HIGHWAY 126 STE A
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9626
Practice Address - Country:US
Practice Address - Phone:425-891-0332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty