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General NPI Number Information
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NPI Number | 1831126374
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Entity Type | Organization
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Legal Business Name | SUNNYSIDE NURSING HOME
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 16561 US HIGHWAY 10
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City | LAKE PARK
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State | MN
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Zip | 56554-9302
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Country | US
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Telephone | 218-238-5944
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Fax | 218-238-6854
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Provider Business Mailing Address
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Address Line | 16561 US HIGHWAY 10
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City | LAKE PARK
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State | MN
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Zip | 56554-9302
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Country | US
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Telephone | 218-238-5944
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Fax | 218-238-6854
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | SCOTT REED RIDDLE
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Credential |
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Telephone | 615-766-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 00016
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License Number State | MN
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