Healthcare Provider Details

I. General information

NPI: 1427304559
Provider Name (Legal Business Name): SUNNY BOWER ALF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 71ST ST NW
BRADENTON FL
34209-1129
US

IV. Provider business mailing address

1604 71ST ST NW
BRADENTON FL
34209-1129
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-2144
  • Fax: 941-795-6374
Mailing address:
  • Phone: 941-792-2144
  • Fax: 941-795-6374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAL5178
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberAL5178
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL5178
License Number StateFL

VIII. Authorized Official

Name: MRS. MARIA A GRUMLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 941-792-2144