MEDICARE: SUNRISE GUEST HOME, INC.

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	347005040	CA

General Provider Information

NPI Number	:	1194168039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE GUEST HOME, INC.

Provider Business Mailing Address
First Line	:	8818 SHARKEY AVE
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1859
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8818 SHARKEY AVE
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1859
Country	:	US
Telephone Number	:	916-714-0853
Fax Number	:

Authorized Official
Title or Position	:	LICENSEE/ADMINISTRATOR
Name	:	MRS. MYRNA DESCARGAR
Credential	:
Telephone Number	:	916-524-9612

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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