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General NPI Number Information
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NPI Number | 1336528629
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Entity Type | Organization
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Legal Business Name | SUNSTONE ASSISTED LIVING LLC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 7945 31ST AVE
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City | KENOSHA
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State | WI
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Zip | 53142-4617
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Country | US
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Telephone | 262-412-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 7945 31ST AVE
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City | KENOSHA
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State | WI
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Zip | 53142-4617
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Country | US
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Telephone | 262-412-4002
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ROBERT KAY TURNER
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Credential | MBA
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Telephone | 262-412-4002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 0015292
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 0014539
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License Number State | WI
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