Organization
SUNNYSIDE NURSING HOME
Active
Other names
Sunnyside Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT REED RIDDLE (VP OF FINANCE)
(615) 766-4300
Entity
Organization
Contact information
Practice address
16561 US HIGHWAY 10, LAKE PARK, MN 56554-9302
(218) 238-5944
(218) 238-6854
Mailing address
16561 US HIGHWAY 10, LAKE PARK, MN 56554-9302
(218) 238-5944
(218) 238-6854
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
00016
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030315
—
ND
01
—
710042
MEDICA
MN
05
—
863840300
—
MN
01
—
9513SU
BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/28/2006
Last updated
09/12/2012
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