Provider Demographics
NPI:1508239351
Name:PACIFIC SUNRISE HOME INC.
Entity Type:Organization
Organization Name:PACIFIC SUNRISE HOME INC.
Other - Org Name:PACIFIC SUNRISE HOME 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LOIDA
Authorized Official - Last Name:CANTORIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-500-7223
Mailing Address - Street 1:28122 LOMO DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3226
Mailing Address - Country:US
Mailing Address - Phone:424-777-8602
Mailing Address - Fax:424-206-9069
Practice Address - Street 1:28122 LOMO DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-3226
Practice Address - Country:US
Practice Address - Phone:424-777-8602
Practice Address - Fax:424-206-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197608243310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197608243OtherDEPARTMENT OF SOCIAL SERVICES