Provider Demographics
NPI:1477797173
Name:SUNNY BROOK LIVING CARE CENTER, L.C.
Entity Type:Organization
Organization Name:SUNNY BROOK LIVING CARE CENTER, L.C.
Other - Org Name:SUNNY BROOK LIVING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-472-4111
Mailing Address - Street 1:400 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-0588
Mailing Address - Country:US
Mailing Address - Phone:641-472-4111
Mailing Address - Fax:641-469-4375
Practice Address - Street 1:400 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-0588
Practice Address - Country:US
Practice Address - Phone:641-472-4111
Practice Address - Fax:641-469-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA511120314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA165602Medicare Oscar/Certification