Healthcare Provider Details

I. General information

NPI: 1336528629
Provider Name (Legal Business Name): SUNSTONE ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 31ST AVE
KENOSHA WI
53142-4617
US

IV. Provider business mailing address

7945 31ST AVE
KENOSHA WI
53142-4617
US

V. Phone/Fax

Practice location:
  • Phone: 262-412-4002
  • Fax:
Mailing address:
  • Phone: 262-412-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0014539
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number0015292
License Number StateWI

VIII. Authorized Official

Name: ROBERT KAY TURNER
Title or Position: MEMBER
Credential: MBA
Phone: 262-412-4002