MEDICARE: SUNRISE IRRIGATION 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	372500000X	Chore Provider

General Provider Information

NPI Number	:	1609579192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE IRRIGATION LLC

Provider Business Mailing Address
First Line	:	490 SMILEY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-2237
Country	:	US
Telephone Number	:	513-413-9567
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 SMILEY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-2237
Country	:	US
Telephone Number	:	513-413-9567
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CYNTHIA AVALOS
Credential	:
Telephone Number	:	513-413-9567

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	03/29/2023

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