Healthcare Provider Details

I. General information

NPI: 1134804099
Provider Name (Legal Business Name): SUNRISE HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 12/16/2023
Certification Date: 12/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 HUTTON AVE
FARMINGTON NM
87402-7601
US

IV. Provider business mailing address

1305 HUTTON AVE
FARMINGTON NM
87402-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-330-6953
  • Fax:
Mailing address:
  • Phone: 505-330-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HEATHER ROSE CHARLIE
Title or Position: OWNER/ADMINSTRATOR
Credential: NCPT
Phone: 505-330-6953