Provider Demographics
NPI:1639266851
Name:SUNRISE MANOR & CONVALESCENT CENTER INC
Entity Type:Organization
Organization Name:SUNRISE MANOR & CONVALESCENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEEKER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:513-797-5144
Mailing Address - Street 1:PO BOX 54923
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45254-0923
Mailing Address - Country:US
Mailing Address - Phone:513-797-5144
Mailing Address - Fax:513-797-4627
Practice Address - Street 1:3434 STATE ROUTE 132
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-2012
Practice Address - Country:US
Practice Address - Phone:513-797-5144
Practice Address - Fax:513-797-4627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1221N313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0157619Medicaid
OH366288Medicare ID - Type Unspecified