MEDICARE: SUNRISE HAVEN LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1578429858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE HAVEN LLC

Provider Business Mailing Address
First Line	:	4732 ARDMORE LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-5041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4732 ARDMORE LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-5041
Country	:	US
Telephone Number	:	757-779-4493
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANTHONY PETERKIN
Credential	:
Telephone Number	:	757-779-4493

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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