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NPI Code Detail

MEDICARE: SUNNY KNOLL CARE CENTER, LLC

MEDICARE: SUNNY KNOLL CARE CENTER, LLC
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
1314000000XSkilled Nursing Facility130168IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508828120
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNNY KNOLL CARE CENTER, LLC
Provider Business Mailing Address
First Line : 5115 E STATE ROAD 64
Second Line :
City : BRADENTON
State : FL
Zip : 34208-5509
Country : US
Telephone Number : 941-758-4745
Fax Number : 941-751-2135
Provider Business Practice Location Address
First Line : 135 WARNER ST
Second Line :
City : ROCKWELL CITY
State : IA
Zip : 50579-1722
Country : US
Telephone Number : 712-297-8918
Fax Number : 712-297-5535
Authorized Official
Title or Position : AUTHORIZED REPRESENTATIVE
Name : MR. GREGORY S BENCH
Credential :
Telephone Number : 941-758-4745
Provider Enumeration Date : 04/06/2006
Last Update Date : 10/04/2017

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Directions to “SUNNY KNOLL CARE CENTER, LLC ” Practice Location

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