1801014964 NPI number — SUNNYBROOK ASSISTED LIVING MT. PLEASANT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801014964 NPI number — SUNNYBROOK ASSISTED LIVING MT. PLEASANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNNYBROOK ASSISTED LIVING MT. PLEASANT
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:
Provider Other Organization Name Type Code:
6
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:
1801014964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1406 E LINDEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52641-1891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-385-7227
Provider Business Mailing Address Fax Number:
319-385-3909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1406 E LINDEN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52641-1891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-385-7227
Provider Business Practice Location Address Fax Number:
319-385-3909
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VAN AMERONGEN
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
RUTH
Authorized Official Title or Position:
ASSISTANT MANAGER
Authorized Official Telephone Number:
319-385-7227

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  S0208 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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