Healthcare Provider Details

I. General information

NPI: 1770373755
Provider Name (Legal Business Name): SUNNY SANDS MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 SUNNYSANDS DR
PERRIS CA
92570
US

IV. Provider business mailing address

12930 ELM CREST CT
YUCAIPA CA
92399-5704
US

V. Phone/Fax

Practice location:
  • Phone: 210-323-1677
  • Fax:
Mailing address:
  • Phone: 210-323-1677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MARK HOWDER
Title or Position: CFO
Credential: PARAMEDIC
Phone: 210-323-1677