- Enrollment id
- O20250905000059
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1417638958
- Multiple npi flag
- N
- Ccn
- 369451
- Associate id
- 7618479080
- Organization name
- SUNRISE HEALTHCARE SERVICES LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2101 S HAMILTON RD
- Address line 2
- STE 108
- City
- COLUMBUS
- State
- OH
- Zip code
- 432324144