Provider Demographics
NPI:1871200121
Name:SUNRISE RESIDENTIAL SERVICES LLC
Entity type:Organization
Organization Name:SUNRISE RESIDENTIAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-465-8087
Mailing Address - Street 1:216 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2429
Mailing Address - Country:US
Mailing Address - Phone:651-528-6363
Mailing Address - Fax:612-314-8590
Practice Address - Street 1:216 MAPLE LN
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2429
Practice Address - Country:US
Practice Address - Phone:651-528-6363
Practice Address - Fax:612-314-8590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility