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General NPI Number Information
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NPI Number | 1619004314
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Entity Type | Organization
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Legal Business Name | SUNNYSIDE RETIREMENT HOME
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1600 US HIGHWAY 221 S
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City | FOREST CITY
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State | NC
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Zip | 28043-7052
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Country | US
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Telephone | 828-286-3025
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Fax | 828-286-9669
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Provider Business Mailing Address
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Address Line | 1600 US HIGHWAY 221 S
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City | FOREST CITY
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State | NC
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Zip | 28043-7052
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Country | US
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Telephone | 828-286-3025
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Fax | 828-286-9669
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MICHAEL WAYNE WELLMON JR.
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Credential | PRESIDENT
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Telephone | 704-300-7646
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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 |
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License Number State |
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