Provider Demographics
NPI:1497856785
Name:SUNNY ACRES
Entity Type:Organization
Organization Name:SUNNY ACRES
Other - Org Name:SUNNY ACRES NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-823-7135
Mailing Address - Street 1:19130 SUNNY ACRES RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62675-7306
Mailing Address - Country:US
Mailing Address - Phone:217-632-2334
Mailing Address - Fax:217-632-7092
Practice Address - Street 1:19130 SUNNY ACRES RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IL
Practice Address - Zip Code:62675-7306
Practice Address - Country:US
Practice Address - Phone:217-632-2334
Practice Address - Fax:217-632-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005009314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL146068Medicare ID - Type Unspecified