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General NPI Number Information
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NPI Number | 1881362986
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Entity Type | Organization
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Legal Business Name | SUNRISE HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 167 PRIMROSE CT
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127-6154
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Country | US
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Telephone | 763-639-9537
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 270125
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127-0125
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Country | US
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Telephone | 763-639-9537
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Fax |
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Authorized Official
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Title or Position | DON
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Name | MR. WILSON K MABWAI
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Credential | RN
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Telephone | 763-639-9537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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