MEDICARE: SUNRISE PERSONAL CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1124841531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE PERSONAL CARE LLC

Provider Business Mailing Address
First Line	:	225 S STEPHANIE ST APT 424
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-4409
Country	:	US
Telephone Number	:	702-408-5272
Fax Number	:

Provider Business Practice Location Address
First Line	:	5115 WILD CREEK FALLS WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-8635
Country	:	US
Telephone Number	:	702-408-5272
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINSTRATOR
Name	:	HAZEM SALEM
Credential	:
Telephone Number	:	702-408-2572

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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