MEDICARE: SUNRISE NURSING HOME INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	3702311N	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396741773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE NURSING HOME INC.

Provider Business Mailing Address
First Line	:	17 SUNRISE DR
Second Line	:
City	:	OSWEGO
State	:	NY
Zip	:	13126-1838
Country	:	US
Telephone Number	:	315-342-4790
Fax Number	:	315-342-5365

Provider Business Practice Location Address
First Line	:	17 SUNRISE DR
Second Line	:
City	:	OSWEGO
State	:	NY
Zip	:	13126-1838
Country	:	US
Telephone Number	:	315-342-4790
Fax Number	:	315-342-5365

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. STEVEN REYNOLDS
Credential	:
Telephone Number	:	315-342-4790

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/22/2020

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