Provider Demographics
NPI:1073570594
Name:SUNRISE LIFESTYLE CENTERS LLC
Entity Type:Organization
Organization Name:SUNRISE LIFESTYLE CENTERS LLC
Other - Org Name:SUNRISE HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:T
Authorized Official - Last Name:GRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-656-0353
Mailing Address - Street 1:40 SKOKIE BLVD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1601
Mailing Address - Country:US
Mailing Address - Phone:847-656-0353
Mailing Address - Fax:847-656-0358
Practice Address - Street 1:8 SADDLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1902
Practice Address - Country:US
Practice Address - Phone:973-455-1122
Practice Address - Fax:973-455-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23200261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD31-4518Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER