Healthcare Provider Details

I. General information

NPI: 1730549866
Provider Name (Legal Business Name): SUNRISE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NE BIRCH ST
COUPEVILLE WA
98239-3133
US

IV. Provider business mailing address

PO BOX 2569
EVERETT WA
98213-0569
US

V. Phone/Fax

Practice location:
  • Phone: 425-212-4200
  • Fax:
Mailing address:
  • Phone: 425-212-4211
  • Fax: 425-347-0492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number600231010
License Number StateWA

VIII. Authorized Official

Name: MS. SUE A. CLOSSER
Title or Position: OWNER
Credential:
Phone: 425-212-4211