Provider Demographics
NPI:1578892840
Name:METSUN JACKSON NJ SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:METSUN JACKSON NJ SENIOR LIVING, LLC
Other - Org Name:SUNRISE OF JACKSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:MAJA
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:CALA
Authorized Official - Phone:732-928-5600
Mailing Address - Street 1:7900 WESTPARK DR
Mailing Address - Street 2:SUITE T-900
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7900 WESTPARK DR
Practice Address - Street 2:SUITE T-900
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4242
Practice Address - Country:US
Practice Address - Phone:732-928-5600
Practice Address - Fax:732-928-5601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE SENIOR LIVING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ15A112310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility