Provider Demographics
NPI:1932237443
Name:SUNRISE SENIOR LIVING SERVICES
Entity Type:Organization
Organization Name:SUNRISE SENIOR LIVING SERVICES
Other - Org Name:BRIGHTON GARDENS OF SANTA ROSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-566-8600
Mailing Address - Street 1:7900 WESTPARK DR STE T900
Mailing Address - Street 2:M. GARCIA, MEDICARE BILLING
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4217
Mailing Address - Country:US
Mailing Address - Phone:703-854-0823
Mailing Address - Fax:703-854-0164
Practice Address - Street 1:300 FOUNTAIN GROVE PKWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-5720
Practice Address - Country:US
Practice Address - Phone:707-566-8600
Practice Address - Fax:707-566-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-10-17
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
CA555836Medicare ID - Type Unspecified