Provider Demographics
NPI:1013188861
Name:SUNRISE THIRD (POOL 1), LLC.
Entity Type:Organization
Organization Name:SUNRISE THIRD (POOL 1), LLC.
Other - Org Name:SUNRISE OF FLOSSMOOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GENAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-798-1600
Mailing Address - Street 1:19715 GOVERNORS HWY
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1794
Mailing Address - Country:US
Mailing Address - Phone:708-798-1600
Mailing Address - Fax:708-798-3406
Practice Address - Street 1:19715 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1794
Practice Address - Country:US
Practice Address - Phone:708-798-1600
Practice Address - Fax:708-798-3406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility