MEDICARE: SUNBURST CARE CENTER #3

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	LTC61026F	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LTC61026F	OTHER	CA	MEDI CAL

General Provider Information

NPI Number	:	1356550529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNBURST CARE CENTER #3

Provider Business Mailing Address
First Line	:	19684 LOS ALIMOS ST
Second Line	:
City	:	CHATSWORTH
State	:	CA
Zip	:	91311-1934
Country	:	US
Telephone Number	:	818-831-0625
Fax Number	:	818-368-3638

Provider Business Practice Location Address
First Line	:	16518 TUPPER ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-2833
Country	:	US
Telephone Number	:	818-892-8840
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY TREASURER
Name	:	MR. PERRY EDWARD RASO
Credential	:
Telephone Number	:	818-831-0625

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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