Provider Demographics
NPI:1982750998
Name:SUNRISE THIRD (POOL IV), LLC
Entity Type:Organization
Organization Name:SUNRISE THIRD (POOL IV), LLC
Other - Org Name:SUNRISE ASSISTED LIVING OF MARLBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTERWEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-409-6665
Mailing Address - Street 1:3A S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1537
Mailing Address - Country:US
Mailing Address - Phone:732-409-6665
Mailing Address - Fax:
Practice Address - Street 1:3A S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1537
Practice Address - Country:US
Practice Address - Phone:732-409-6665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0L9278310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0006327Medicaid