Healthcare Provider Details

I. General information

NPI: 1982281846
Provider Name (Legal Business Name): BAMBOO SUNRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E LAKE MEAD PKWY STE 201
HENDERSON NV
89015-6443
US

IV. Provider business mailing address

98 E LAKE MEAD PKWY STE 201
HENDERSON NV
89015-6443
US

V. Phone/Fax

Practice location:
  • Phone: 702-433-3038
  • Fax: 702-433-2210
Mailing address:
  • Phone: 702-433-3038
  • Fax: 702-433-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY HOLDEMAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 702-433-3038