Provider Demographics
NPI:1932722139
Name:SUNRISE RETIREMENT HOME LLC
Entity Type:Organization
Organization Name:SUNRISE RETIREMENT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA ELSIE
Authorized Official - Middle Name:TUMAOB
Authorized Official - Last Name:LABIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-550-6468
Mailing Address - Street 1:200 SOUTHEAST LINCOLN CIRCLE NORTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703
Mailing Address - Country:US
Mailing Address - Phone:727-550-6488
Mailing Address - Fax:727-520-9314
Practice Address - Street 1:4201 70TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781
Practice Address - Country:US
Practice Address - Phone:727-623-4156
Practice Address - Fax:727-520-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility