Provider Demographics
NPI:1073919304
Name:SUNRISE ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:SUNRISE ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARITTE
Authorized Official - Middle Name:T
Authorized Official - Last Name:ODRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-229-8883
Mailing Address - Street 1:8421 GREENHILL WAY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-5433
Mailing Address - Country:US
Mailing Address - Phone:907-229-8883
Mailing Address - Fax:
Practice Address - Street 1:8421 GREENHILL WAY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-5433
Practice Address - Country:US
Practice Address - Phone:907-229-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101062310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility