Provider Demographics
NPI:1881362986
Name:SUNRISE HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:SUNRISE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:MR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:K
Authorized Official - Last Name:MABWAI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:763-639-9537
Mailing Address - Street 1:PO BOX 270125
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-0125
Mailing Address - Country:US
Mailing Address - Phone:763-639-9537
Mailing Address - Fax:
Practice Address - Street 1:167 PRIMROSE CT
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-6154
Practice Address - Country:US
Practice Address - Phone:763-639-9537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care