MEDICARE: SUNRISE ENTERPRISE LLC

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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1922289073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	PO BOX 244
Second Line	:
City	:	MORNING SUN
State	:	IA
Zip	:	52640-0244
Country	:	US
Telephone Number	:	319-385-2910
Fax Number	:	319-385-2913

Provider Business Practice Location Address
First Line	:	606 SPRING ST
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-4926
Country	:	US
Telephone Number	:	319-753-2400
Fax Number	:	319-753-2400

Authorized Official
Title or Position	:	CEO
Name	:	MONTA CITA SAXON
Credential	:	LISW
Telephone Number	:	319-385-2910

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	11/16/2007

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Directions to “SUNRISE ENTERPRISE LLC ” Practice Location

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