MEDICARE: SUNNY DAYS ALF,INC II

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	AL10988	FL

General Provider Information

NPI Number	:	1972807071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNNY DAYS ALF,INC II

Provider Business Mailing Address
First Line	:	4645 SW VAHALLA ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-6776
Country	:	US
Telephone Number	:	772-285-2466
Fax Number	:

Provider Business Practice Location Address
First Line	:	4645 SW VAHALLA ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-6776
Country	:	US
Telephone Number	:	772-285-2466
Fax Number	:

Authorized Official
Title or Position	:	RN/OWNER/ADM
Name	:	KELLY ANN POWERS SALVATO
Credential	:
Telephone Number	:	772-285-2466

Provider Enumeration Date	:	01/04/2011
Last Update Date	:	01/04/2011

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