Provider Demographics
NPI:1144628421
Name:SUNROSE
Entity type:Organization
Organization Name:SUNROSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNDAY
Authorized Official - Middle Name:ENMIL
Authorized Official - Last Name:PASTORES
Authorized Official - Suffix:
Authorized Official - Credentials:TRANSPORTATION
Authorized Official - Phone:708-945-5793
Mailing Address - Street 1:4220 W BELMONT AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4620
Mailing Address - Country:US
Mailing Address - Phone:708-945-5793
Mailing Address - Fax:708-453-2372
Practice Address - Street 1:4220 W BELMONT AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4620
Practice Address - Country:US
Practice Address - Phone:708-945-5793
Practice Address - Fax:708-453-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILP23678563200343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA2741KD1Medicaid