MEDICARE: SUNRISE ASSISTED LIVING I & II 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
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1518551027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE ASSISTED LIVING I & II LLC

Provider Business Mailing Address
First Line	:	8037 COUNTRY WOODS DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-4691
Country	:	US
Telephone Number	:	907-350-3098
Fax Number	:	907-868-1229

Provider Business Practice Location Address
First Line	:	6261 COLLINS WAY
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-2147
Country	:	US
Telephone Number	:	907-350-3098
Fax Number	:	907-868-1229

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	JERLYN ODRON
Credential	:
Telephone Number	:	907-350-3098

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	02/24/2021

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