Provider Demographics
NPI:1487094223
Name:SUNRISE HEALTHCARE, LLC
Entity type:Organization
Organization Name:SUNRISE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACKIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:812-405-2125
Mailing Address - Street 1:410 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2370
Mailing Address - Country:US
Mailing Address - Phone:812-405-2125
Mailing Address - Fax:812-405-2425
Practice Address - Street 1:1171 WEST TIPTON ST
Practice Address - Street 2:SUITE E
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2793
Practice Address - Country:US
Practice Address - Phone:812-405-2125
Practice Address - Fax:812-405-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1453Medicare PIN