Healthcare Provider Details

I. General information

NPI: 1649271966
Provider Name (Legal Business Name): SUNLAND HEALTH ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 S 48TH ST
MESA AZ
85206-1250
US

IV. Provider business mailing address

51 S 48TH ST
MESA AZ
85206-1250
US

V. Phone/Fax

Practice location:
  • Phone: 480-832-8333
  • Fax: 480-830-2466
Mailing address:
  • Phone: 480-832-8333
  • Fax: 480-830-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI2638
License Number StateAZ

VII. Legacy identifiers

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

# 1
Identifier820391
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name: MS. SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249