Healthcare Provider Details

I. General information

NPI: 1790694677
Provider Name (Legal Business Name): SONNY INDEPENDENT LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15440 UTAH ST
CLEARLAKE CA
95422-8384
US

IV. Provider business mailing address

PO BOX 5103
CONCORD CA
94524-0103
US

V. Phone/Fax

Practice location:
  • Phone: 510-932-0196
  • Fax:
Mailing address:
  • Phone: 510-932-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CHERYL SWANK
Title or Position: FOUNDER
Credential: CEO
Phone: 510-932-0196