Provider Demographics
NPI:1295992246
Name:SUN HEALTH GRANDVIEW TERRACE, LLP
Entity type:Organization
Organization Name:SUN HEALTH GRANDVIEW TERRACE, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BHAKTI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-975-8030
Mailing Address - Street 1:14515 W GRANITE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6021
Mailing Address - Country:US
Mailing Address - Phone:623-975-8042
Mailing Address - Fax:
Practice Address - Street 1:14515 W GRANITE VALLEY DR
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6021
Practice Address - Country:US
Practice Address - Phone:623-975-8042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN HEALTH GRANDVIEW TERRACE, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-19
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 3844261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC 3844OtherARIZONA DEPARTMENT OF HEALTH SERVICES LICENSE