Healthcare Provider Details

I. General information

NPI: 1669383642
Provider Name (Legal Business Name): SUNRIDGE ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 LANDON DR
BULLHEAD CITY AZ
86429-7674
US

IV. Provider business mailing address

839 LANDON DR
BULLHEAD CITY AZ
86429-7674
US

V. Phone/Fax

Practice location:
  • Phone: 928-754-0700
  • Fax:
Mailing address:
  • Phone: 928-754-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: IRINI GONZALES
Title or Position: ADMINISTRATOR
Credential:
Phone: 928-754-0700