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General NPI Number Information
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NPI Number | 1801484571
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Entity Type | Organization
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Legal Business Name | SDK SUNRISE LLC
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 601 GRAHAM RD
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City | COLLEGE STATION
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State | TX
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Zip | 77845-9664
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Country | US
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Telephone | 796-617-2729
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Fax |
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Provider Business Mailing Address
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Address Line | 601 GRAHAM RD
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City | COLLEGE STATION
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State | TX
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Zip | 77845-9664
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Country | US
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Telephone | 979-661-7272
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | SIMEON ETTA
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Credential |
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Telephone | 979-436-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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