1639266851 NPI number — SUNRISE MANOR & CONVALESCENT CENTER INC

Table of content: (NPI 1639266851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639266851 NPI number — SUNRISE MANOR & CONVALESCENT CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNRISE MANOR & CONVALESCENT CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639266851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 54923
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45254-0923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-797-5144
Provider Business Mailing Address Fax Number:
513-797-4627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3434 STATE ROUTE 132
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMELIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45102-2012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-797-5144
Provider Business Practice Location Address Fax Number:
513-797-4627
Provider Enumeration Date:
10/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEEKER
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BOARD OF DIRECTOR
Authorized Official Telephone Number:
513-797-5144

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  1221N , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 314000000X , with the licence number: 1221N , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0157619 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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