Provider Demographics
NPI:1336528629
Name:SUNSTONE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:SUNSTONE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:262-412-4002
Mailing Address - Street 1:7945 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4617
Mailing Address - Country:US
Mailing Address - Phone:262-412-4002
Mailing Address - Fax:
Practice Address - Street 1:7945 31ST AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4617
Practice Address - Country:US
Practice Address - Phone:262-412-4002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0014539310400000X
WI0015292311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)