MEDICARE: SUNRISE HOME HEALTH CARE, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1679806434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE HOME HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	1711 1/2 E LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-5754
Country	:	US
Telephone Number	:	612-721-9001
Fax Number	:	612-721-9002

Provider Business Practice Location Address
First Line	:	1711 1/2 E LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-5754
Country	:	US
Telephone Number	:	612-721-9001
Fax Number	:	612-721-9002

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MOHAMED OMAR DAKANE JR.
Credential	:
Telephone Number	:	612-721-9001

Provider Enumeration Date	:	09/11/2009
Last Update Date	:	09/11/2009

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