Provider Demographics
NPI:1205826773
Name:SUNNYSIDE PRESBYTERIAN HOME
Entity type:Organization
Organization Name:SUNNYSIDE PRESBYTERIAN HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-568-8206
Mailing Address - Street 1:600 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE L
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3763
Mailing Address - Country:US
Mailing Address - Phone:540-568-8237
Mailing Address - Fax:540-568-8248
Practice Address - Street 1:3935 SUNNYSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-2328
Practice Address - Country:US
Practice Address - Phone:540-568-8505
Practice Address - Fax:540-568-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVLO-05-231310400000X
VANH2700314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4953871Medicaid
VA495387Medicare ID - Type Unspecified