Provider Demographics
NPI:1699770909
Name:SUNRISE HEALTH SERVICES INC
Entity type:Organization
Organization Name:SUNRISE HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-462-9331
Mailing Address - Street 1:22350 SUNRISE RD NE
Mailing Address - Street 2:
Mailing Address - City:STACY
Mailing Address - State:MN
Mailing Address - Zip Code:55079-9383
Mailing Address - Country:US
Mailing Address - Phone:651-462-9331
Mailing Address - Fax:651-462-5761
Practice Address - Street 1:22350 SUNRISE RD NE
Practice Address - Street 2:
Practice Address - City:STACY
Practice Address - State:MN
Practice Address - Zip Code:55079-9383
Practice Address - Country:US
Practice Address - Phone:651-462-9331
Practice Address - Fax:651-462-5761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327775251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5900108OtherMEDICA
MN70418OtherHEALTH PARTNERS
MN129413OtherUCARE
MN180021OtherUCARE EW
MN5C46SUOtherBC BS
MN180020OtherUCARE PCA
MN180020OtherUCARE PCA