Provider Demographics
NPI:1104895325
Name:SUNRISE HAVEN
Entity type:Organization
Organization Name:SUNRISE HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMAREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-813-2096
Mailing Address - Street 1:24423 100TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4846
Mailing Address - Country:US
Mailing Address - Phone:253-813-2096
Mailing Address - Fax:253-852-5887
Practice Address - Street 1:24423 100TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030
Practice Address - Country:US
Practice Address - Phone:253-813-2096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1315282J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA501992Medicare ID - Type Unspecified