Provider Demographics
NPI:1871988840
Name:SUN RISE HOSPICE CARE LLC
Entity type:Organization
Organization Name:SUN RISE HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEKUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-644-8303
Mailing Address - Street 1:13658 HAWTHORNE BLVD STE 200B
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5822
Mailing Address - Country:US
Mailing Address - Phone:310-644-8303
Mailing Address - Fax:310-644-8305
Practice Address - Street 1:13658 HAWTHORNE BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5822
Practice Address - Country:US
Practice Address - Phone:310-644-8303
Practice Address - Fax:310-644-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based