Healthcare Provider Details

I. General information

NPI: 1588418412
Provider Name (Legal Business Name): SUNRISE HEALTH CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 KESTREL DR
BELCAMP MD
21017-1709
US

IV. Provider business mailing address

306 KESTREL DR
BELCAMP MD
21017-1709
US

V. Phone/Fax

Practice location:
  • Phone: 443-698-4339
  • Fax:
Mailing address:
  • Phone: 443-698-4339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HOBAHY TALE
Title or Position: RN
Credential:
Phone: 443-698-4339