Provider Demographics
NPI:1891060729
Name:SUNSET HARBOR ASSISTED LIVING
Entity Type:Organization
Organization Name:SUNSET HARBOR ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:727-940-4781
Mailing Address - Street 1:5901 US HIGHWAY 19
Mailing Address - Street 2:SUITE 7B
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2960
Mailing Address - Country:US
Mailing Address - Phone:727-940-4781
Mailing Address - Fax:888-688-1401
Practice Address - Street 1:522 DORIC CT
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-2526
Practice Address - Country:US
Practice Address - Phone:727-940-4781
Practice Address - Fax:888-688-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-10
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12109310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility