MEDICARE: SUNRISE CLINICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1659151090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE CLINICS, INC.

Provider Business Mailing Address
First Line	:	6767 W TROPICANA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4754
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6236 LAREDO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5249
Country	:	US
Telephone Number	:	725-500-9500
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	BESCHELLE LOCKHART
Credential	:
Telephone Number	:	702-503-5414

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	11/29/2023

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