Organization
SUNRISE LIFESTYLE CENTERS LLC
Active
Parent organization
SUNRISE LIFESTYLE CENTERS LLC
Other names
Sunrise Health Centers
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNRISE LIFESTYLE CENTERS LLC
Authorized official
JEFF T GRADE (CEO)
(847) 656-0353
Entity
Organization
Contact information
Practice address
658 KENILWORTH DR, SUITE 100, TOWSON, MD 21204-2312
(410) 296-4901
(410) 296-4971
Mailing address
40 SKOKIE BLVD, SUITE 440, NORTHBROOK, IL 60062-1601
(847) 656-0353
(847) 656-0358
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21-4530
MEDICARE PROVIDER #
MD
Enumeration date
04/27/2006
Last updated
09/12/2007
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