Healthcare Provider Details

I. General information

NPI: 1033029756
Provider Name (Legal Business Name): SUNNY WAY CONGREGATE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11452 SUNNY WAY
VICTORVILLE CA
92392-8110
US

IV. Provider business mailing address

9452 SKYLARK BLVD
GARDEN GROVE CA
92841-2019
US

V. Phone/Fax

Practice location:
  • Phone: 714-623-0859
  • Fax:
Mailing address:
  • Phone: 714-623-0859
  • 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: ANNA NGUYEN DE LOS REYES
Title or Position: ADMINISTRATOR ASSISTANT- LVN
Credential:
Phone: 714-276-7052