Healthcare Provider Details

I. General information

NPI: 1699770909
Provider Name (Legal Business Name): SUNRISE HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22350 SUNRISE RD NE
STACY MN
55079-9383
US

IV. Provider business mailing address

22350 SUNRISE RD NE
STACY MN
55079-9383
US

V. Phone/Fax

Practice location:
  • Phone: 651-462-9331
  • Fax: 651-462-5761
Mailing address:
  • Phone: 651-462-9331
  • Fax: 651-462-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number327775
License Number StateMN

VIII. Authorized Official

Name: MR. PAUL ANDERSON
Title or Position: CFO OWNER
Credential:
Phone: 651-462-9331