MEDICARE: SUNROSE

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	343900000X	Non-emergency Medical Transport (VAN)	P23678563200	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144628421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNROSE

Provider Business Mailing Address
First Line	:	4220 W BELMONT AVE
Second Line	:	SUITE 207
City	:	CHICAGO
State	:	IL
Zip	:	60641-4620
Country	:	US
Telephone Number	:	708-945-5793
Fax Number	:	708-453-2372

Provider Business Practice Location Address
First Line	:	4220 W BELMONT AVE
Second Line	:	SUITE 207
City	:	CHICAGO
State	:	IL
Zip	:	60641-4620
Country	:	US
Telephone Number	:	708-945-5793
Fax Number	:	708-453-2372

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	MR. SUNDAY ENMIL PASTORES
Credential	:	TRANSPORTATION
Telephone Number	:	708-945-5793

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	12/18/2014

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Directions to “SUNROSE ” Practice Location

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