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General NPI Number Information
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NPI Number | 1114137601
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Entity Type | Organization
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Legal Business Name | SUNSET PARK PLACE CO
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3730 PENNSYLVANIA AVE
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City | DUBUQUE
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State | IA
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Zip | 52002-3701
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Country | US
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Telephone | 563-583-7939
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Fax | 563-583-2982
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Provider Business Mailing Address
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Address Line | 3730 PENNSYLVANIA AVE
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City | DUBUQUE
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State | IA
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Zip | 52002-3701
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Country | US
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Telephone | 563-583-7939
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Fax | 563-583-2982
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Authorized Official
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Title or Position | MANAGER
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Name | JERRY BELL
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Credential |
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Telephone | 563-583-7939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | S0127
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License Number State | IA
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