Healthcare Provider Details

I. General information

NPI: 1902005382
Provider Name (Legal Business Name): SUNRISE COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 3RD ST SE STE 150
LOVELAND CO
80537-6419
US

IV. Provider business mailing address

2930 11TH AVE
EVANS CO
80620
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-4855
  • Fax: 970-669-7389
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateCO

VIII. Authorized Official

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