Healthcare Provider Details

I. General information

NPI: 1609848183
Provider Name (Legal Business Name): SUNRISE MEDICAL SERVICES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6698 WASHINGTON RD
APPLING GA
30802-4120
US

IV. Provider business mailing address

454C FURYS FERRY RD
AUGUSTA GA
30907-9506
US

V. Phone/Fax

Practice location:
  • Phone: 706-541-0462
  • Fax: 706-541-0310
Mailing address:
  • Phone: 706-650-8922
  • Fax: 706-650-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-036-1197
License Number StateGA

VIII. Authorized Official

Name: MR. WILLIAM T MCKETTRICK
Title or Position: CEO
Credential:
Phone: 706-650-8922