Provider Demographics
NPI:1578907093
Name:SUNRISE BLOOMFIELD SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:SUNRISE BLOOMFIELD SENIOR LIVING, LLC
Other - Org Name:SUNRISE ASSISTED LIVING OF BLOOMFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-972-0800
Mailing Address - Street 1:2080 S. TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48302-9998
Mailing Address - Country:US
Mailing Address - Phone:248-972-0800
Mailing Address - Fax:248-972-0900
Practice Address - Street 1:2080 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48302-0247
Practice Address - Country:US
Practice Address - Phone:248-972-0800
Practice Address - Fax:248-972-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAH630281890310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility