=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104434547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNRISE SENIOR LIVING MANAGEMENT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2020
-----------------------------------------------------
Last Update Date | 07/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23599 SE ISSAQUAH FALL CITY RD
-----------------------------------------------------
City | ISSAQUAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98029-9265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-945-0006
-----------------------------------------------------
Fax | 425-945-0007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23599 SE ISSAQUAH FALL CITY RD
-----------------------------------------------------
City | ISSAQUAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98029-9265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-945-0006
-----------------------------------------------------
Fax | 425-945-0007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP - OPERATIONS
-----------------------------------------------------
Name | JEFFREY SLICHTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 425-945-0006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------