Provider Demographics
NPI:1891032124
Name:SUNRISE HOUSE ASSISTED LIVING HOME II
Entity Type:Organization
Organization Name:SUNRISE HOUSE ASSISTED LIVING HOME II
Other - Org Name:SUNRISE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:907-631-3971
Mailing Address - Street 1:801 S HERMON RD
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7311
Mailing Address - Country:US
Mailing Address - Phone:907-631-3971
Mailing Address - Fax:907-631-4085
Practice Address - Street 1:801 S HERMON RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7311
Practice Address - Country:US
Practice Address - Phone:907-631-3971
Practice Address - Fax:907-631-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100986310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility