Provider Demographics
NPI:1508828120
Name:SUNNY KNOLL CARE CENTER, LLC
Entity Type:Organization
Organization Name:SUNNY KNOLL CARE CENTER, LLC
Other - Org Name:SUNNY KNOLL CARE CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-758-4745
Mailing Address - Street 1:5115 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5509
Mailing Address - Country:US
Mailing Address - Phone:941-758-4745
Mailing Address - Fax:941-751-2135
Practice Address - Street 1:135 WARNER ST
Practice Address - Street 2:
Practice Address - City:ROCKWELL CITY
Practice Address - State:IA
Practice Address - Zip Code:50579-1722
Practice Address - Country:US
Practice Address - Phone:712-297-8918
Practice Address - Fax:712-297-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA130168314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803858Medicaid
IA0800076Medicaid
IA0800076Medicaid