Provider Demographics
NPI:1306878152
Name:RISING SUN HOME HEALTH CARE INC.
Entity type:Organization
Organization Name:RISING SUN HOME HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-397-5568
Mailing Address - Street 1:10330 W ROOSEVELT RD STE 310
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2566
Mailing Address - Country:US
Mailing Address - Phone:708-397-5568
Mailing Address - Fax:708-397-5582
Practice Address - Street 1:10330 W ROOSEVELT RD STE 310
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2566
Practice Address - Country:US
Practice Address - Phone:708-397-5568
Practice Address - Fax:708-397-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010465251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147875OtherCMS PROVIDER NUMBER
IL147875OtherCMS PROVIDER NUMBER