Healthcare Provider Details

I. General information

NPI: 1043937576
Provider Name (Legal Business Name): SUNRISE COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 MONROE AVE
LOVELAND CO
80538-3274
US

IV. Provider business mailing address

2930 11TH AVE
EVANS CO
80620-1011
US

V. Phone/Fax

Practice location:
  • Phone: 970-613-6800
  • Fax: 970-613-6801
Mailing address:
  • Phone: 970-613-6800
  • Fax: 970-613-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CATHY WOLFF
Title or Position: CFO
Credential:
Phone: 970-346-2546