MEDICARE: SUNRISE HOME HEALTH AGENCY

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

General Provider Information

NPI Number	:	1649542069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE HOME HEALTH AGENCY

Provider Business Mailing Address
First Line	:	225 FAIRWAY BLVD STE 203
Second Line	:
City	:	WHITEHALL
State	:	OH
Zip	:	43213-2071
Country	:	US
Telephone Number	:	614-657-2387
Fax Number	:	614-635-6370

Provider Business Practice Location Address
First Line	:	225 FAIRWAY BLVD STE 203
Second Line	:
City	:	WHITEHALL
State	:	OH
Zip	:	43213-2071
Country	:	US
Telephone Number	:	614-657-2387
Fax Number	:	614-635-6370

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. ASTEWALECH WASSIHUN
Credential	:
Telephone Number	:	614-657-2387

Provider Enumeration Date	:	01/31/2012
Last Update Date	:	01/31/2012

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Directions to “SUNRISE HOME HEALTH AGENCY ” Practice Location

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