Healthcare Provider Details

I. General information

NPI: 1053886010
Provider Name (Legal Business Name): SUNRISE COMMUNITY LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 SUNRISE DR
ANCHORAGE AK
99508-3347
US

IV. Provider business mailing address

800 LIGHTHOUSE CT
ANCHORAGE AK
99515-3669
US

V. Phone/Fax

Practice location:
  • Phone: 907-644-0929
  • Fax: 907-339-4876
Mailing address:
  • Phone: 907-360-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRANDON BOWDEN
Title or Position: OWNER
Credential:
Phone: 907-360-2266