Provider Demographics
NPI:1366913931
Name:SUN RISEON THE SOUTH HOME CARE & TRANSPORTATION
Entity type:Organization
Organization Name:SUN RISEON THE SOUTH HOME CARE & TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATION
Authorized Official - Prefix:MS
Authorized Official - First Name:MAKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NDIAYE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:804-605-7573
Mailing Address - Street 1:3000 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23834-5230
Mailing Address - Country:US
Mailing Address - Phone:804-605-7573
Mailing Address - Fax:804-203-5733
Practice Address - Street 1:3000 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23834-5230
Practice Address - Country:US
Practice Address - Phone:804-605-7573
Practice Address - Fax:804-203-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0002068703OtherNURSING