Provider Demographics
NPI:1912540196
Name:SUN VILLA ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:SUN VILLA ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HERO
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRIANSYAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-388-5249
Mailing Address - Street 1:304 S PEORIA CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2246
Mailing Address - Country:US
Mailing Address - Phone:720-531-4182
Mailing Address - Fax:
Practice Address - Street 1:304 S PEORIA CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2246
Practice Address - Country:US
Practice Address - Phone:720-531-4182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility