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	251E00000X	Home Health Agency	7763PCS-0	NV

General Provider Information

NPI Number	:	1295169696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE PERSONAL CARE LLC

Provider Business Mailing Address
First Line	:	5160 S EASTERN AVE
Second Line	:	SUITE C
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2300
Country	:	US
Telephone Number	:	702-353-0602
Fax Number	:

Provider Business Practice Location Address
First Line	:	5160 S EASTERN AVE
Second Line	:	SUITE C
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2300
Country	:	US
Telephone Number	:	702-353-0602
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIRIAM NALLELY PERDOMO-AGUILAR
Credential	:
Telephone Number	:	702-353-0602

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	11/21/2013

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