MEDICARE: SUNRAY OPERATING COMPANY 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	314000000X	Skilled Nursing Facility		CA

Other Identifiers

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

General Provider Information

NPI Number	:	1770571465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRAY OPERATING COMPANY LLC

Provider Business Mailing Address
First Line	:	10654 BALBOA BLVD
Second Line	:	ACCOUNTING OFFICE
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6385
Country	:	US
Telephone Number	:	818-368-5200
Fax Number	:	818-368-1300

Provider Business Practice Location Address
First Line	:	3210 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3643
Country	:	US
Telephone Number	:	818-368-1862
Fax Number	:	818-368-8079

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ROBERT REISS
Credential	:
Telephone Number	:	818-368-5200

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	01/29/2008

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