Provider Demographics
NPI:1730721432
Name:SUNNYSIDE ASSISTED LIVING HOME LLC/SUNNYSIDE ASSISTED LIVING HOME LLC,
Entity type:Organization
Organization Name:SUNNYSIDE ASSISTED LIVING HOME LLC/SUNNYSIDE ASSISTED LIVING HOME LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESPRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPENDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-630-1715
Mailing Address - Street 1:18006 N 6TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6489
Mailing Address - Country:US
Mailing Address - Phone:602-626-8257
Mailing Address - Fax:602-688-5424
Practice Address - Street 1:18006 N 6TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6489
Practice Address - Country:US
Practice Address - Phone:602-626-8257
Practice Address - Fax:602-688-5424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility