Basic Information
| Provider Information | |||||||||
| NPI: | 1639635683 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNNY RIDGE NURSING AND REHABILITATION CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 MAIN AVE STE 121 | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070141748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086277100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3014 ERIE AVE | ||||||||
| Address2: | |||||||||
| City: | SHEBOYGAN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530813658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204593028 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2019 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRICK | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9204593028 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.