# SUNNYSIDE MANOR INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sunnyside Manor
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417093501
- **Authorized official:** MRS. MARYELLEN KEANE LNHA (ADMINISTRATOR)
- **Authorized official phone:** (732) 528-9311

## Contact information

- **Practice address:** 2500 RIDGEWOOD RD, WALL TOWNSHIP, NJ 07719-9600
- **Practice address phone:** (732) 528-9311
- **Practice address fax:** (732) 528-9026
- **Mailing address:** 2500 RIDGEWOOD RD, WALL TOWNSHIP, NJ 07719-9600
- **Mailing address phone:** (732) 528-9311
- **Mailing address fax:** (732) 528-9026

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 061329 | NJ | Yes |

## Other

- **Enumeration date:** 01/29/2007
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7902506 | — | NJ |
| 01 | — | 9652 | EMPIRE PROVIDER NUMBER | NJ |