Provider Demographics
NPI:1659573699
Name:SUNNYSIDE WEST
Entity Type:Organization
Organization Name:SUNNYSIDE WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ION
Authorized Official - Middle Name:
Authorized Official - Last Name:URSACIUC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-466-1936
Mailing Address - Street 1:5249 E TIERRA BUENA LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1768
Mailing Address - Country:US
Mailing Address - Phone:602-466-1936
Mailing Address - Fax:
Practice Address - Street 1:5249 E TIERRA BUENA LN
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1768
Practice Address - Country:US
Practice Address - Phone:602-466-1936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH5275261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care