Basic Information
| Provider Information | |||||||||
| NPI: | 1164662680 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUNRISE EASTOVER ASSISTED LIVING, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUNRISE SENIOR LIVING OF EASTOVER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3610 RANDOLPH RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282111318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043662550 | ||||||||
| FaxNumber: | 7043664041 | ||||||||
| Practice Location | |||||||||
| Address1: | 3610 RANDOLPH RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282111318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043662550 | ||||||||
| FaxNumber: | 7043664041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2009 | ||||||||
| LastUpdateDate: | 02/24/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TOWER | ||||||||
| AuthorizedOfficialFirstName: | CODY | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7043662550 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.