Healthcare Provider Details

I. General information

NPI: 1497856785
Provider Name (Legal Business Name): SUNNY ACRES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19130 SUNNY ACRES RD
PETERSBURG IL
62675-7306
US

IV. Provider business mailing address

19130 SUNNY ACRES RD
PETERSBURG IL
62675-7306
US

V. Phone/Fax

Practice location:
  • Phone: 217-632-2334
  • Fax: 217-632-7092
Mailing address:
  • Phone: 217-632-2334
  • Fax: 217-632-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0005009
License Number StateIL

VIII. Authorized Official

Name: DAVID UNDERWOOD
Title or Position: EXEC VP & CFO
Credential:
Phone: 309-823-7135