Basic Information
| Provider Information | |||||||||
| NPI: | 1750334918 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNRISE SENIOR LIVING SERVICES, INC | ||||||||
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| OtherOrganizationName: | THE JEFFERSON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7900 WESTPARK DR | ||||||||
| Address2: | T-900, ATT: MEDICARE BILLING | ||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221024242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038540823 | ||||||||
| FaxNumber: | 7038540164 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 N TAYLOR ST | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222031858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035169455 | ||||||||
| FaxNumber: | 7035169459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 05/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHULNAM | ||||||||
| AuthorizedOfficialFirstName: | JERALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7035169455 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH2599 | VA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 49522693 | 05 | VA | MEDICAID |