MEDICARE: SUNRIDGE VILLAGE 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	920	AZ

General Provider Information

NPI Number	:	1699817734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRIDGE VILLAGE LLC

Provider Business Mailing Address
First Line	:	839 LANDON DR
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86429-7674
Country	:	US
Telephone Number	:	928-754-0700
Fax Number	:	928-754-1225

Provider Business Practice Location Address
First Line	:	839 LANDON DR
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86429-7674
Country	:	US
Telephone Number	:	928-754-0700
Fax Number	:	928-754-1225

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CINDY TRITZ
Credential	:
Telephone Number	:	928-754-0700

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	06/18/2008

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