Provider Demographics
NPI:1124841531
Name:SUNRISE PERSONAL CARE LLC
Entity type:Organization
Organization Name:SUNRISE PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HAZEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-408-2572
Mailing Address - Street 1:225 S STEPHANIE ST APT 424
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4409
Mailing Address - Country:US
Mailing Address - Phone:702-408-5272
Mailing Address - Fax:
Practice Address - Street 1:5115 WILD CREEK FALLS WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-8635
Practice Address - Country:US
Practice Address - Phone:702-408-5272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care