Provider Demographics
NPI:1861640013
Name:SUNRISE MOUNTAIN ASSISTED LIVING, INC
Entity Type:Organization
Organization Name:SUNRISE MOUNTAIN ASSISTED LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-262-6240
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:AK
Mailing Address - Zip Code:99672-0882
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39160 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:AK
Practice Address - Zip Code:99672
Practice Address - Country:US
Practice Address - Phone:907-262-6240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100686310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility