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General NPI Number Information
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NPI Number | 1710394424
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Entity Type | Organization
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Legal Business Name | SUNRISE HOME CARE AGENCY, LLC
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 157 N MAIN ST STE R2
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City | SUFFOLK
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State | VA
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Zip | 23434-4565
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Country | US
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Telephone | 757-539-4663
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Fax | 757-539-4661
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Provider Business Mailing Address
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Address Line | PO BOX 5292
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City | SUFFOLK
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State | VA
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Zip | 23435-0292
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Country | US
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Telephone | 757-539-4663
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Fax | 757-539-4661
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. LESLIE LENOR MOORE
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Credential |
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Telephone | 757-539-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO-141078
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License Number State | VA
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