1558319236 NPI number — SUNRISE HOME HEALTH SERVICES OF AMERICA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558319236 NPI number — SUNRISE HOME HEALTH SERVICES OF AMERICA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNRISE HOME HEALTH SERVICES OF AMERICA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558319236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 494728
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75049-4728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-278-1414
Provider Business Mailing Address Fax Number:
972-278-1413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 ARISTA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKWALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75032-6657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-278-1414
Provider Business Practice Location Address Fax Number:
972-278-1413
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WIGHTMAN
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING DIRECTOR
Authorized Official Telephone Number:
972-278-1414

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  001939 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 024513601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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