Basic Information
| Provider Information | |||||||||
| NPI: | 1770520868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNRISE HOSPITAL AND MEDICAL CENTER, LLC | ||||||||
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| OtherOrganizationName: | SUNRISE HOSPITAL AND MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3186 S MARYLAND PKWY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891092317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027318000 | ||||||||
| FaxNumber: | 7027318668 | ||||||||
| Practice Location | |||||||||
| Address1: | 3186 S MARYLAND PKWY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891092317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027318000 | ||||||||
| FaxNumber: | 7027318668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 08/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | ARAD | ||||||||
| AuthorizedOfficialFirstName: | LANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7027318706 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 1002878 | 05 | NV | MEDICAID |