Healthcare Provider Details

I. General information

NPI: 1508603937
Provider Name (Legal Business Name): AMERICAN SUNRISE CARE-ASC-LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/12/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9276 OLD KEENE MILL ROAD
BURKE VA
22015
US

IV. Provider business mailing address

9276 OLD KEENE MILL ROAD
BURKE VA
22015
US

V. Phone/Fax

Practice location:
  • Phone: 571-516-3116
  • Fax: 571-516-3070
Mailing address:
  • Phone: 571-516-3116
  • Fax: 571-516-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JESSICA KENNENY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 540-312-3230