Provider Demographics
NPI:1477537199
Name:SENIOR CARE GROUP OF MCDOWELL LLC
Entity Type:Organization
Organization Name:SENIOR CARE GROUP OF MCDOWELL LLC
Other - Org Name:SUNRISE REHABILITATION AND CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUDOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-341-2735
Mailing Address - Street 1:1240 MARBELLA PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7904
Mailing Address - Country:US
Mailing Address - Phone:813-341-2700
Mailing Address - Fax:813-676-0125
Practice Address - Street 1:306 DEER PARK RD
Practice Address - Street 2:
Practice Address - City:NEBO
Practice Address - State:NC
Practice Address - Zip Code:28761-8746
Practice Address - Country:US
Practice Address - Phone:828-652-3032
Practice Address - Fax:828-656-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0326314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415233Medicaid
NC3415233Medicaid