Healthcare Provider Details

I. General information

NPI: 1245797968
Provider Name (Legal Business Name): SUNRISE MOUNTAIN HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10323 W OLIVE AVE
PEORIA AZ
85345-7345
US

IV. Provider business mailing address

10323 W OLIVE AVE
PEORIA AZ
85345-7345
US

V. Phone/Fax

Practice location:
  • Phone: 623-875-0100
  • Fax: 602-457-7069
Mailing address:
  • Phone: 623-875-0100
  • Fax: 623-875-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 949-487-9500