Provider Demographics
NPI:1386097046
Name:SUNNY RIDGE MANOR
Entity type:Organization
Organization Name:SUNNY RIDGE MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FEMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-526-7983
Mailing Address - Street 1:1201 POST RD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2002
Mailing Address - Country:US
Mailing Address - Phone:714-526-7983
Mailing Address - Fax:
Practice Address - Street 1:1201 POST RD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2002
Practice Address - Country:US
Practice Address - Phone:714-526-7983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306002108313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
306002108OtherCOMMUNITY CARE LICENSING