Healthcare Provider Details

I. General information

NPI: 1326935875
Provider Name (Legal Business Name): SUNRISE LOVELY MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 COCHRAN ST
SIMI VALLEY CA
93065-2160
US

IV. Provider business mailing address

1635 COCHRAN ST
SIMI VALLEY CA
93065-2160
US

V. Phone/Fax

Practice location:
  • Phone: 805-210-2900
  • Fax: 805-791-3755
Mailing address:
  • Phone: 805-304-5960
  • 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: MR. SLIM MARON
Title or Position: OWNER
Credential:
Phone: 805-304-5960