Provider Demographics
NPI:1184214561
Name:SUNRISE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:SUNRISE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:207-904-9005
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:JONESPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04649-0507
Mailing Address - Country:US
Mailing Address - Phone:207-497-4133
Mailing Address - Fax:207-497-4133
Practice Address - Street 1:11 OCEAN ST
Practice Address - Street 2:
Practice Address - City:JONESPORT
Practice Address - State:ME
Practice Address - Zip Code:04649-3376
Practice Address - Country:US
Practice Address - Phone:207-497-4133
Practice Address - Fax:207-497-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility