Provider Demographics
NPI:1316252638
Name:SUNNY CREST HOME
Entity type:Organization
Organization Name:SUNNY CREST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-286-5000
Mailing Address - Street 1:2587 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543-9102
Mailing Address - Country:US
Mailing Address - Phone:610-286-5000
Mailing Address - Fax:610-286-7799
Practice Address - Street 1:2587 VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:PA
Practice Address - Zip Code:19543-9102
Practice Address - Country:US
Practice Address - Phone:610-286-5000
Practice Address - Fax:610-286-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA321920311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home