Provider Demographics
NPI:1619004314
Name:SUNNYSIDE RETIREMENT HOME
Entity Type:Organization
Organization Name:SUNNYSIDE RETIREMENT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WELLMON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:704-300-7646
Mailing Address - Street 1:1600 US HIGHWAY 221 S
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-7052
Mailing Address - Country:US
Mailing Address - Phone:828-286-3025
Mailing Address - Fax:828-286-9669
Practice Address - Street 1:1600 US HIGHWAY 221 S
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-7052
Practice Address - Country:US
Practice Address - Phone:828-286-3025
Practice Address - Fax:828-286-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility