Provider Demographics
NPI:1770571465
Name:SUNRAY OPERATING COMPANY LLC
Entity type:Organization
Organization Name:SUNRAY OPERATING COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-368-5200
Mailing Address - Street 1:10654 BALBOA BLVD
Mailing Address - Street 2:ACCOUNTING OFFICE
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6385
Mailing Address - Country:US
Mailing Address - Phone:818-368-5200
Mailing Address - Fax:818-368-1300
Practice Address - Street 1:3210 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3643
Practice Address - Country:US
Practice Address - Phone:818-368-1862
Practice Address - Fax:818-368-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05870HMedicaid
05 5870Medicare ID - Type Unspecified
CAZZT05870HMedicaid