Healthcare Provider Details

I. General information

NPI: 1922896927
Provider Name (Legal Business Name): SUN RIZE RESIDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S SMITHFIELD RD
KNIGHTDALE NC
27545-7781
US

IV. Provider business mailing address

PO BOX 94
CLAYTON NC
27528-0094
US

V. Phone/Fax

Practice location:
  • Phone: 919-664-2155
  • Fax:
Mailing address:
  • Phone: 919-809-0852
  • Fax: 844-859-3904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TIESHQUANNA C RICHARDSON
Title or Position: CEO
Credential:
Phone: 919-664-2155