MEDICARE: SUNRISE STARSHINE HOSPICE, INC.

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1144890062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE STARSHINE HOSPICE, INC.

Provider Business Mailing Address
First Line	:	2211 S HACIENDA BLVD STE 209
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-4609
Country	:	US
Telephone Number	:	626-934-1777
Fax Number	:	626-934-9999

Provider Business Practice Location Address
First Line	:	2211 S HACIENDA BLVD STE 209
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-4609
Country	:	US
Telephone Number	:	626-934-1777
Fax Number	:	626-934-9999

Authorized Official
Title or Position	:	CFO/BM/ADM/DPCS DESIGNEE
Name	:	SOHRAB ARYAN
Credential	:	RN
Telephone Number	:	626-934-1777

Provider Enumeration Date	:	07/01/2021
Last Update Date	:	07/01/2021

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