Healthcare Provider Details

I. General information

NPI: 1285372334
Provider Name (Legal Business Name): SUNRISE COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 MAIN ST UNIT G
WINDSOR CO
80550-4847
US

IV. Provider business mailing address

2930 11TH AVE
EVANS CO
80620-1011
US

V. Phone/Fax

Practice location:
  • Phone: 970-378-7740
  • Fax: 970-561-7159
Mailing address:
  • Phone: 970-350-4606
  • Fax: 970-350-4692

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 State

VIII. Authorized Official

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