Provider Demographics
NPI:1194977488
Name:RISING SUN RESIDENTIAL CARE FACILITY INC
Entity type:Organization
Organization Name:RISING SUN RESIDENTIAL CARE FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:469-245-4990
Mailing Address - Street 1:325 SQUIREBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2914
Mailing Address - Country:US
Mailing Address - Phone:469-245-4990
Mailing Address - Fax:
Practice Address - Street 1:419 BUCKINGHAM PL
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5605
Practice Address - Country:US
Practice Address - Phone:972-230-8828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities