MEDICARE: SUNRISE HEALTHCARE GROUP, 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	314000000X	Skilled Nursing Facility	1320N	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699036228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE HEALTHCARE GROUP, LLC

Provider Business Mailing Address
First Line	:	26691 RICHMOND RD
Second Line	:
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-1421
Country	:	US
Telephone Number	:	216-292-5706
Fax Number	:	216-292-2273

Provider Business Practice Location Address
First Line	:	19900 CLARE AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1806
Country	:	US
Telephone Number	:	216-662-3343
Fax Number	:	216-662-1887

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	WILLIAM I. WEISBERG
Credential	:
Telephone Number	:	216-292-5706

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	05/22/2013

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