Provider Demographics
NPI:1518956911
Name:SUNNYSIDE PRESBYTERIAN HOME
Entity Type:Organization
Organization Name:SUNNYSIDE PRESBYTERIAN HOME
Other - Org Name:SUMMIT SQUARE RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-568-8237
Mailing Address - Street 1:600 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3763
Mailing Address - Country:US
Mailing Address - Phone:540-568-8237
Mailing Address - Fax:540-568-8248
Practice Address - Street 1:501 OAK AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-4400
Practice Address - Country:US
Practice Address - Phone:540-941-3100
Practice Address - Fax:540-941-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1022567310400000X
VANH2740314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4954051Medicaid