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General NPI Number Information
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NPI Number | 1073357422
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Entity Type | Organization
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Legal Business Name | SUNRISE HOME HEALTH OF IDAHO
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 1254 E PUFFIN ST
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City | MERIDIAN
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State | ID
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Zip | 83642-7453
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Country | US
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Telephone | 208-918-0080
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Fax |
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Provider Business Mailing Address
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Address Line | 1254 E PUFFIN ST
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City | MERIDIAN
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State | ID
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Zip | 83642-7453
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Country | US
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Telephone | 480-247-0622
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. RACHELLE RAUMA
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Credential | M.S. CCC-SLP
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Telephone | 208-918-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 364SH0200X
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Taxonomy Name | Home Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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