Healthcare Provider Details

I. General information

NPI: 1801635008
Provider Name (Legal Business Name): SUNSTAR VILLAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 65TH WAY N
PINELLAS PARK FL
33781-3116
US

IV. Provider business mailing address

7575 65TH WAY N
PINELLAS PARK FL
33781-3116
US

V. Phone/Fax

Practice location:
  • Phone: 727-601-3916
  • Fax:
Mailing address:
  • Phone: 727-601-3916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNA LYMONOVA
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-601-3916