Provider Demographics
NPI:1316932569
Name:SUNRISE COUNTRY INC
Entity type:Organization
Organization Name:SUNRISE COUNTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEMAR
Authorized Official - Middle Name:TIM
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-761-3230
Mailing Address - Street 1:610 224TH RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NE
Mailing Address - Zip Code:68405-8475
Mailing Address - Country:US
Mailing Address - Phone:402-761-3230
Mailing Address - Fax:402-761-3283
Practice Address - Street 1:610 224TH RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NE
Practice Address - Zip Code:68405-8475
Practice Address - Country:US
Practice Address - Phone:402-761-3230
Practice Address - Fax:402-761-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE724002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid
NE0621600001Medicare NSC