Healthcare Provider Details

I. General information

NPI: 1124990031
Provider Name (Legal Business Name): SUNRISE CARE PCA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5039 SPENCER ST UNIT A
LAS VEGAS NV
89119-2180
US

IV. Provider business mailing address

5039 SPENCER ST UNIT A
LAS VEGAS NV
89119-2180
US

V. Phone/Fax

Practice location:
  • Phone: 702-415-7974
  • Fax:
Mailing address:
  • Phone: 702-415-7974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: YOUSSRA BOUDRIF
Title or Position: OWNER
Credential:
Phone: 702-415-7974