Provider Demographics
NPI:1356729461
Name:SUNRISE PERSONAL CARE
Entity type:Organization
Organization Name:SUNRISE PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:NALLELY
Authorized Official - Last Name:PERDOMO-AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-750-1629
Mailing Address - Street 1:5160 S EASTERN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2300
Mailing Address - Country:US
Mailing Address - Phone:702-750-1629
Mailing Address - Fax:702-750-1647
Practice Address - Street 1:5160 S EASTERN AVE STE E
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2300
Practice Address - Country:US
Practice Address - Phone:702-750-1629
Practice Address - Fax:702-750-1647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1760812317Medicaid