MEDICARE: SUN PEAK HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1093311284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN PEAK HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	4400 E BROADWAY BLVD STE 405
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3517
Country	:	US
Telephone Number	:	520-577-4630
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 E BROADWAY BLVD STE 405
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3517
Country	:	US
Telephone Number	:	520-577-4630
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	AMBER L TUELLER
Credential	:
Telephone Number	:	208-207-2726

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	06/10/2025

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