Organization
NIC 4 SUNSET LAKE LEASING
Active
Other names
Sunset Lake Village
Organization subpart
No
Provider details
NPI number
Authorized official
JANE RYU (PRESIDENT/CEO/CFO)
(212) 479-5270
Entity
Organization
Contact information
Practice address
1121 JACARANDA BLVD., VENICE, FL 34292
(941) 497-1117
(941) 492-3455
Mailing address
C/O HOLIDAY RETIREMENT, PO BOX 1700, NIC 4 SUNSET LAKE LEASING, LAKE OSWEGO, OR 97035
(971) 245-8020
(503) 431-2295
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
9325
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003067300
MEDICAID AGED/DISABLED ADULTS
FL
Enumeration date
04/29/2013
Last updated
12/01/2016
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