Provider Demographics
NPI:1801484571
Name:SDK SUNRISE LLC
Entity type:Organization
Organization Name:SDK SUNRISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SIMEON
Authorized Official - Middle Name:
Authorized Official - Last Name:ETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-436-1616
Mailing Address - Street 1:601 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-9664
Mailing Address - Country:US
Mailing Address - Phone:979-661-7272
Mailing Address - Fax:
Practice Address - Street 1:601 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-9664
Practice Address - Country:US
Practice Address - Phone:796-617-2729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty