MEDICARE: SUNRISE GUEST HOME 1 & 2

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	347000538	CA
2	310400000X	Assisted Living Facility	347001937	CA

General Provider Information

NPI Number	:	1063697829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE GUEST HOME 1 & 2

Provider Business Mailing Address
First Line	:	8705 GREAT CT
Second Line	:	8818 SHARKEY AVE
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1873
Country	:	US
Telephone Number	:	916-714-0853
Fax Number	:	916-685-6910

Provider Business Practice Location Address
First Line	:	8818 SHARKEY AVE
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1873
Country	:	US
Telephone Number	:	916-714-0853
Fax Number	:	916-685-6910

Authorized Official
Title or Position	:	LICENSEE/ADMINISTRATOR
Name	:	MRS. MYRNA QUE DESCARGAR
Credential	:	LVN
Telephone Number	:	916-714-0853

Provider Enumeration Date	:	12/29/2007
Last Update Date	:	06/23/2008

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