Basic Information
| Provider Information | |||||||||
| NPI: | 1861439952 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUNRISE HOSPITAL AND MEDICAL CENTER, LLC | ||||||||
| LastName: | |||||||||
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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: | 06/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | ARAD | ||||||||
| AuthorizedOfficialFirstName: | LANA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7027318706 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 110931600 | 05 | WY | MEDICAID | 4102345 | 05 | MT | MEDICAID | 00308800 | 05 | ID | MEDICAID | 020842 | 05 | AZ | MEDICAID | 880106347003 | 05 | UT | MEDICAID | HSP60161G | 05 | CA | MEDICAID | NV2320 | 01 | NV | BLUE CROSS | OTHER | 000451 | 05 | OR | MEDICAID | 001102878 | 05 | NV | MEDICAID | 3014792 | 05 | WA | MEDICAID | HS813IP | 05 | AK | MEDICAID |