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General NPI Number Information
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NPI Number | 1891807277
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Entity Type | Organization
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Legal Business Name | SUNRISE PRIMARY CARE SERVICES INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 1100 N MAIN ST STE 201
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City | BOERNE
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State | TX
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Zip | 78006-3086
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Country | US
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Telephone | 830-331-2005
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Fax | 830-331-2045
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Provider Business Mailing Address
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Address Line | 604 N. MAIN STREET SUITE 300
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City | BOERNE
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State | TX
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Zip | 78006-9999
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Country | US
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Telephone | 830-331-2005
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Fax | 830-331-2045
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SCOTT GALLIARDT
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Credential | RN
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Telephone | 830-331-2005
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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 | 008948
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License Number State | TX
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