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General NPI Number Information
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NPI Number | 1942787189
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Entity Type | Organization
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Legal Business Name | SUNRISE CONSULTANT SERVICES, INC
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 502 W 138TH STREET
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City | RIVERDALE
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State | IL
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Zip | 60827-6082
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Country | US
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Telephone | 312-778-4258
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Fax | 708-880-1239
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Provider Business Mailing Address
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Address Line | 502 W 138TH STREET
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City | RIVERDALE
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State | IL
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Zip | 60827
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Country | US
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Telephone | 312-778-4258
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Fax | 708-880-1239
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Authorized Official
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Title or Position | MSN, RN
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Name | YVETTA L MASSEY
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Credential | YVETTA L MASSEY
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Telephone | 708-880-1397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 041265569
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License Number State | IL
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