Healthcare Provider Details

I. General information

NPI: 1255255949
Provider Name (Legal Business Name): SUNRISE MANOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 W CHANNEL ISLANDS BLVD
OXNARD CA
93033-4407
US

IV. Provider business mailing address

441 W CHANNEL ISLANDS BLVD
OXNARD CA
93033-4407
US

V. Phone/Fax

Practice location:
  • Phone: 805-240-7600
  • Fax: 805-240-9945
Mailing address:
  • Phone: 805-240-7600
  • Fax: 805-240-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STACEY K MEDINA
Title or Position: HEAD ADMINISTRATOR
Credential:
Phone: 213-503-1998