Provider Demographics
NPI:1013398122
Name:MOR/SUN SHELBY SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:MOR/SUN SHELBY SENIOR LIVING, LLC
Other - Org Name:SUNRISE ASSISTED LIVING OF SHELBY TWP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-532-9559
Mailing Address - Street 1:46471 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5504
Mailing Address - Country:US
Mailing Address - Phone:586-532-9559
Mailing Address - Fax:586-532-9554
Practice Address - Street 1:46471 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-5504
Practice Address - Country:US
Practice Address - Phone:586-532-9559
Practice Address - Fax:586-532-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAH500281087310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility