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General NPI Number Information
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NPI Number | 1104895325
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Entity Type | Organization
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Legal Business Name | SUNRISE HAVEN
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 24423 100TH AVE SE
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City | KENT
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State | WA
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Zip | 98030
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Country | US
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Telephone | 253-813-2096
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Fax |
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Provider Business Mailing Address
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Address Line | 24423 100TH AVE SE
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City | KENT
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State | WA
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Zip | 98030-4846
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Country | US
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Telephone | 253-813-2096
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Fax | 253-852-5887
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | BONNIE DEMAREE
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Credential |
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Telephone | 253-813-2096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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License Number | 1315
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License Number State | WA
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