Provider Demographics
NPI:1760043350
Name:SUNRISE SENIOR HOME
Entity Type:Organization
Organization Name:SUNRISE SENIOR HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GHEBRE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:206-235-1402
Mailing Address - Street 1:3526 168TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3233
Mailing Address - Country:US
Mailing Address - Phone:206-235-1402
Mailing Address - Fax:206-420-6115
Practice Address - Street 1:1820 224TH ST SW
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9214
Practice Address - Country:US
Practice Address - Phone:206-235-1402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty