Provider Demographics
NPI:1417906470
Name:SUNRISE SENIOR LIVING SERVICES, INC.
Entity Type:Organization
Organization Name:SUNRISE SENIOR LIVING SERVICES, INC.
Other - Org Name:BRIGHTON GARDENS OF NORTHRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-886-1616
Mailing Address - Street 1:7900 WESTPARK DR
Mailing Address - Street 2:T-900, ATTN: MEDICARE BILLING, M. GARCIA
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4242
Mailing Address - Country:US
Mailing Address - Phone:703-854-0823
Mailing Address - Fax:703-854-0164
Practice Address - Street 1:17650 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1445
Practice Address - Country:US
Practice Address - Phone:818-886-1616
Practice Address - Fax:818-886-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197605521314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555791Medicare ID - Type Unspecified