Healthcare Provider Details

I. General information

NPI: 1881362986
Provider Name (Legal Business Name): SUNRISE HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 PRIMROSE CT
VADNAIS HEIGHTS MN
55127-6154
US

IV. Provider business mailing address

PO BOX 270125
VADNAIS HEIGHTS MN
55127-0125
US

V. Phone/Fax

Practice location:
  • Phone: 763-639-9537
  • Fax:
Mailing address:
  • Phone: 763-639-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WILSON K MABWAI
Title or Position: DON
Credential: RN
Phone: 763-639-9537