Healthcare Provider Details

I. General information

NPI: 1831815950
Provider Name (Legal Business Name): SUNRISE ADHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N MAIN ST
PROVIDENCE RI
02904-5700
US

IV. Provider business mailing address

72 FRENCH ST
PAWTUCKET RI
02860-4212
US

V. Phone/Fax

Practice location:
  • Phone: 857-250-5123
  • Fax:
Mailing address:
  • Phone: 857-250-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. AKINSIJI TAIWO
Title or Position: MANAGER
Credential:
Phone: 857-250-5123