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General NPI Number Information
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NPI Number | 1174483085
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Entity Type | Organization
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Legal Business Name | SUNRISE COMMUNITY HEALTH
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 500 24TH AVE STE A
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City | GREELEY
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State | CO
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Zip | 80634-2617
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Country | US
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Telephone | 970-353-9403
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Fax |
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Provider Business Mailing Address
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Address Line | 2930 11TH AVE
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City | EVANS
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State | CO
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Zip | 80620-1011
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MITZI MORAN
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Credential |
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Telephone | 970-350-4606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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