Healthcare Provider Details

I. General information

NPI: 1679498935
Provider Name (Legal Business Name): SUNRISE RESIDENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 9TH ST
ECORSE MI
48229-1612
US

IV. Provider business mailing address

4015 9TH ST
ECORSE MI
48229-1612
US

V. Phone/Fax

Practice location:
  • Phone: 313-748-5538
  • Fax:
Mailing address:
  • Phone: 313-748-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GLORIA HIGHTOWER
Title or Position: OWNER
Credential:
Phone: 313-748-5538