Healthcare Provider Details

I. General information

NPI: 1053799692
Provider Name (Legal Business Name): SUNRISE HOUSE ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 TODDS LN
HAMPTON VA
23666-1934
US

IV. Provider business mailing address

1310 TODDS LN
HAMPTON VA
23666-1934
US

V. Phone/Fax

Practice location:
  • Phone: 757-896-0800
  • Fax: 757-826-4670
Mailing address:
  • Phone: 757-896-0800
  • Fax: 757-826-4670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC 1045630
License Number StateVA

VIII. Authorized Official

Name: MR. WAYNE HARRISON
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-896-0800