Provider Demographics
NPI:1417445685
Name:SUNNILAND ASSISTED LIVING FACILITY,LLC
Entity Type:Organization
Organization Name:SUNNILAND ASSISTED LIVING FACILITY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-921-3801
Mailing Address - Street 1:4234 SUNNILAND ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1817
Mailing Address - Country:US
Mailing Address - Phone:941-921-3801
Mailing Address - Fax:941-924-9783
Practice Address - Street 1:4234 SUNNILAND ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1817
Practice Address - Country:US
Practice Address - Phone:941-921-3801
Practice Address - Fax:941-924-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8267310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility