Provider Demographics
NPI:1073597746
Name:SUNSET NURSING AND REHABILITATION
Entity Type:Organization
Organization Name:SUNSET NURSING AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-942-4301
Mailing Address - Street 1:232 ACADEMY ST
Mailing Address - Street 2:232 ACADEMY STREET
Mailing Address - City:BOONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13309-1397
Mailing Address - Country:US
Mailing Address - Phone:315-942-4301
Mailing Address - Fax:315-942-5994
Practice Address - Street 1:232 ACADEMY ST
Practice Address - Street 2:232 ACADEMY ST
Practice Address - City:BOONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13309-1397
Practice Address - Country:US
Practice Address - Phone:315-942-4301
Practice Address - Fax:315-942-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3221301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474406Medicaid
NY00474406Medicaid