Provider Demographics
NPI:1770358350
Name:SUNRISE RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:SUNRISE RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NTWARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-525-4780
Mailing Address - Street 1:6743 EASTLAND DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7492
Mailing Address - Country:US
Mailing Address - Phone:317-525-4780
Mailing Address - Fax:
Practice Address - Street 1:1947 ZACHARY LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231-1079
Practice Address - Country:US
Practice Address - Phone:319-521-0642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-23
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities