Provider Demographics
NPI:1720281942
Name:SUNRISE HOME FACILITY I
Entity Type:Organization
Organization Name:SUNRISE HOME FACILITY I
Other - Org Name:SUNRISE HOME FACILITY II
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUBILLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-367-9117
Mailing Address - Street 1:11002 NORTH 66TH STREET
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:480-367-9117
Mailing Address - Fax:
Practice Address - Street 1:11002 NORTH 66TH STREET
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:480-367-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH5605310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility