Provider Demographics
NPI:1972300218
Name:SUNRISE COMMUNITY OUTREACH CENTER INC
Entity type:Organization
Organization Name:SUNRISE COMMUNITY OUTREACH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ASHAMALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-816-1505
Mailing Address - Street 1:2105 BEVERLY BLVD STE 219
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2278
Mailing Address - Country:US
Mailing Address - Phone:213-483-2655
Mailing Address - Fax:
Practice Address - Street 1:2105 BEVERLY BLVD STE 219
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2278
Practice Address - Country:US
Practice Address - Phone:213-483-2655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No251B00000XAgenciesCase Management