Provider Demographics
NPI:1215138839
Name:SUNRISE IV BOCA CIEGA SL, LLC
Entity type:Organization
Organization Name:SUNRISE IV BOCA CIEGA SL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-388-1984
Mailing Address - Street 1:1255 PASADENA AVE S
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-6203
Mailing Address - Country:US
Mailing Address - Phone:800-388-1984
Mailing Address - Fax:
Practice Address - Street 1:1255 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-6203
Practice Address - Country:US
Practice Address - Phone:800-388-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL83310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility