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General NPI Number Information
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NPI Number | 1548633472
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Entity Type | Organization
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Legal Business Name | PACIFIC SUNRISE HOME INC.
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 28134 LOMO DR
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-3226
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Country | US
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Telephone | 424-777-8707
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Fax | 424-206-2486
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Provider Business Mailing Address
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Address Line | 28134 LOMO DR
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-3226
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Country | US
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Telephone | 424-777-8602
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Fax | 424-206-9069
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARIA LOIDA CANTORIA
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Credential |
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Telephone | 310-500-7223
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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 | 197607766
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License Number State | CA
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