Provider Demographics
NPI:1588103121
Name:SUNRISE HOME HEALTH
Entity type:Organization
Organization Name:SUNRISE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:PERDOMO-AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-353-0602
Mailing Address - Street 1:2209 E DESERT INN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3216
Mailing Address - Country:US
Mailing Address - Phone:702-798-0553
Mailing Address - Fax:702-798-0556
Practice Address - Street 1:2209 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3216
Practice Address - Country:US
Practice Address - Phone:702-798-0553
Practice Address - Fax:702-798-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7763PCS-1251E00000X
3747P1801X, 376J00000X, 385H00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty