Provider Demographics
NPI:1770074080
Name:SUNVALE HOMES LLC
Entity type:Organization
Organization Name:SUNVALE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-539-4855
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53201-0017
Mailing Address - Country:US
Mailing Address - Phone:313-282-4953
Mailing Address - Fax:414-464-2353
Practice Address - Street 1:4714 N 58TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218
Practice Address - Country:US
Practice Address - Phone:414-464-2374
Practice Address - Fax:414-464-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0010101251E00000X
WI0014111251E00000X
WI0015427251E00000X
WI0013058251E00000X
WI0013808251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health