Provider Demographics
NPI:1588093322
Name:SUNRISE HOME CARE SERVICES, LLC
Entity type:Organization
Organization Name:SUNRISE HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-468-2619
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:FL
Mailing Address - Zip Code:32044-0213
Mailing Address - Country:US
Mailing Address - Phone:352-468-2619
Mailing Address - Fax:
Practice Address - Street 1:9926 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:FL
Practice Address - Zip Code:32044-4411
Practice Address - Country:US
Practice Address - Phone:352-468-2619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE HOME CARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL50843104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness