Basic Information
Provider Information | |||||||||
NPI: | 1013906981 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SUNRISE SENIOR LIVING SERVICES, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | BRIGHTON GARDENS OF RANCHO MIRAGE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 72201 COUNTRY CLUB DRIVE | ||||||||
Address2: |   | ||||||||
City: | RANCHO MIRAGE | ||||||||
State: | CA | ||||||||
PostalCode: | 922704001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7603405999 | ||||||||
FaxNumber: | 7603419972 | ||||||||
Practice Location | |||||||||
Address1: | 72201 COUNTRY CLUB DR | ||||||||
Address2: |   | ||||||||
City: | RANCHO MIRAGE | ||||||||
State: | CA | ||||||||
PostalCode: | 922704001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7603405999 | ||||||||
FaxNumber: | 7603419972 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/13/2005 | ||||||||
LastUpdateDate: | 04/21/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SHAFFER | ||||||||
AuthorizedOfficialFirstName: | ERNIE | ||||||||
AuthorizedOfficialMiddleName: | C | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 7603405999 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | C.N.H.A. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 555775 | CA | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
No ID Information.