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General NPI Number Information
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NPI Number | 1447304746
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Entity Type | Organization
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Legal Business Name | SUNRISE THIRD (POOL IV), LLC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 404 KING GEORGE RD
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-2808
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Country | US
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Telephone | 908-542-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 404 KING GEORGE RD
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-2808
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Country | US
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Telephone | 908-542-9000
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PAUL GEDBAW
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Credential |
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Telephone | 908-542-9000
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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 | 80A008
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License Number State | NJ
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