1073570594 NPI number — SUNRISE LIFESTYLE CENTERS LLC

Table of content: (NPI 1073570594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073570594 NPI number — SUNRISE LIFESTYLE CENTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNRISE LIFESTYLE CENTERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUNRISE HEALTH CENTERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073570594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 SKOKIE BLVD
Provider Second Line Business Mailing Address:
SUITE 440
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60062-1601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-656-0353
Provider Business Mailing Address Fax Number:
847-656-0358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 SADDLE RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CEDAR KNOLLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07927-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-455-1122
Provider Business Practice Location Address Fax Number:
973-455-7117
Provider Enumeration Date:
04/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRADE
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
847-656-0353

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , with the licence number:  23200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)