Healthcare Provider Details

I. General information

NPI: 1205826773
Provider Name (Legal Business Name): SUNNYSIDE PRESBYTERIAN HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 03/25/2022
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3935 SUNNYSIDE DR SUITE A
HARRISONBURG VA
22801-2328
US

IV. Provider business mailing address

600 UNIVERSITY BLVD SUITE L
HARRISONBURG VA
22801-3763
US

V. Phone/Fax

Practice location:
  • Phone: 540-568-8505
  • Fax: 540-568-8310
Mailing address:
  • Phone: 540-568-8237
  • Fax: 540-568-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberVLO-05-231
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2700
License Number StateVA

VIII. Authorized Official

Name: LISA KANNEY
Title or Position: SENIOR EXECUTIVE ASSISTANT
Credential:
Phone: 540-568-8206