Provider Demographics
NPI:1659839892
Name:SUNRISE ASSISTED LIVING FACILITY, LLC
Entity Type:Organization
Organization Name:SUNRISE ASSISTED LIVING FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-539-8827
Mailing Address - Street 1:PO BOX 8653
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-8653
Mailing Address - Country:US
Mailing Address - Phone:907-539-8827
Mailing Address - Fax:
Practice Address - Street 1:309 ERSKINE AVE APT 208
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6390
Practice Address - Country:US
Practice Address - Phone:907-539-8827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility