MEDICARE: SUNNYSIDE PROPERTIES OF SARASOTA INC.

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	SNF1535096	FL

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	:	1780688739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNNYSIDE PROPERTIES OF SARASOTA INC.

Provider Business Mailing Address
First Line	:	5201 BAHIA VISTA ST
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-2615
Country	:	US
Telephone Number	:	941-371-2729
Fax Number	:	941-378-9728

Provider Business Practice Location Address
First Line	:	5201 BAHIA VISTA ST
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-2615
Country	:	US
Telephone Number	:	941-371-2729
Fax Number	:	941-378-9728

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. J DAVID YODER
Credential	:
Telephone Number	:	941-371-2750

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	10/05/2015

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