Provider Demographics
NPI:1407011695
Name:SUNRISE/HOV, LP
Entity Type:Organization
Organization Name:SUNRISE/HOV, LP
Other - Org Name:SUNRISE ASSITED LIVING AT MT. LAUREL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:TAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-222-1213
Mailing Address - Street 1:400 FERN BROOK LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9542
Mailing Address - Country:US
Mailing Address - Phone:856-888-1213
Mailing Address - Fax:856-802-9749
Practice Address - Street 1:400 FERN BROOK LN
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9542
Practice Address - Country:US
Practice Address - Phone:856-888-1213
Practice Address - Fax:856-802-9749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility