Provider Demographics
NPI:1114231388
Name:SUNSET LAKE VILLAGE, LLC
Entity Type:Organization
Organization Name:SUNSET LAKE VILLAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:FARINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-497-1117
Mailing Address - Street 1:1121 JACARANDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4586
Mailing Address - Country:US
Mailing Address - Phone:941-497-1117
Mailing Address - Fax:941-492-3455
Practice Address - Street 1:1121 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4586
Practice Address - Country:US
Practice Address - Phone:941-497-1117
Practice Address - Fax:941-492-3455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRING HAVEN RETIREMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9325310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility