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General NPI Number Information
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NPI Number | 1053799692
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Entity Type | Organization
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Legal Business Name | SUNRISE HOUSE ADULT DAY CARE
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 1310 TODDS LN
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City | HAMPTON
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State | VA
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Zip | 23666-1934
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Country | US
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Telephone | 757-896-0800
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Fax | 757-826-4670
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Provider Business Mailing Address
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Address Line | 1310 TODDS LN
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City | HAMPTON
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State | VA
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Zip | 23666-1934
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Country | US
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Telephone | 757-896-0800
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Fax | 757-826-4670
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. WAYNE HARRISON
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Credential |
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Telephone | 757-896-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | ADC 1045630
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License Number State | VA
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