Provider Demographics
NPI:1972907707
Name:HCRI GARDNER PARK TENANT TRS, LLC
Entity Type:Organization
Organization Name:HCRI GARDNER PARK TENANT TRS, LLC
Other - Org Name:SUNRISE AT GARDNER PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-246-2800
Mailing Address - Street 1:7902 WESTPARK DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4202
Mailing Address - Country:US
Mailing Address - Phone:703-273-7500
Mailing Address - Fax:
Practice Address - Street 1:73 MARGIN ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1877
Practice Address - Country:US
Practice Address - Phone:978-532-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility