Provider Demographics
NPI:1790298859
Name:GL&SON LLC
Entity Type:Organization
Organization Name:GL&SON LLC
Other - Org Name:SUNRISE ICF DD-N
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GODOFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PATAWARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-786-3860
Mailing Address - Street 1:8010 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-1533
Mailing Address - Country:US
Mailing Address - Phone:916-786-3860
Mailing Address - Fax:916-722-8284
Practice Address - Street 1:8010 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-1533
Practice Address - Country:US
Practice Address - Phone:916-786-3860
Practice Address - Fax:916-722-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility