Provider Demographics
NPI:1366637944
Name:SUNRISE BATH ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:SUNRISE BATH ASSISTED LIVING, LLC
Other - Org Name:SUNRISE OF BATH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-666-7011
Mailing Address - Street 1:101 N CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2422
Mailing Address - Country:US
Mailing Address - Phone:330-666-7011
Mailing Address - Fax:330-665-1493
Practice Address - Street 1:101 N CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2422
Practice Address - Country:US
Practice Address - Phone:330-666-7011
Practice Address - Fax:330-665-1493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility