Provider Demographics
NPI:1316382294
Name:SUNRISE HIGHLAND PARK SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:SUNRISE HIGHLAND PARK SENIOR LIVING, LLC
Other - Org Name:SUNRISE OF HIGHLAND PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:IACOBUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-681-1620
Mailing Address - Street 1:1601 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3522
Mailing Address - Country:US
Mailing Address - Phone:847-681-1620
Mailing Address - Fax:847-681-1720
Practice Address - Street 1:1601 GREENBAY RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3522
Practice Address - Country:US
Practice Address - Phone:847-681-1620
Practice Address - Fax:647-681-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2061025310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility