NPIMap

Organization Active NPI

SJV 1 Edmonds Opco LLC

Doing business as Sunrise of Edmonds

  • Assisted Living Facility
  • Edmonds, WA
National Provider Identifier
1073774436
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
1740 Issued in WA
Legal business name
SJV 1 EDMONDS OPCO LLC
Doing business as
Sunrise of Edmonds
Practice address
750 Edmonds Way
Edmonds, WA 98020-5126
Phone
(425) 673-9700
Fax
(425) 673-9701
NPI assigned
Jun 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Tony J. Harris
Title
Senior Reimbursement Manager
Phone
(703) 854-0830

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 1740 WA Primary
Alzheimer Center (Dementia Center) 311500000X 1740 WA

Addresses

Primary practice location

750 Edmonds Way
Edmonds, WA 98020-5126

Mailing address

750 Edmonds Way
Edmonds, WA 98020-5126
Phone (425) 673-9700

Other names 1

  • Sunrise of Edmonds Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2201124Sunrise of Edmonds750 Edmonds Way, Edmonds, WA 98020Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Sunrise of Cuyahoga Falls21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

750 Edmonds Way
Edmonds, WA 98020
Phone (425) 673-9700

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1073774436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 EDMONDS WAY",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980205126",
            "telephone_number": "425-673-9700",
            "fax_number": "425-673-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 EDMONDS WAY",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980205126",
            "telephone_number": "425-673-9700",
            "fax_number": "425-673-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SJV 1 EDMONDS OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-18",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "SENIOR REIMBURSEMENT MANAGER",
        "authorized_official_telephone_number": "703-854-0830",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WA",
            "license": "1740",
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "WA",
            "license": "1740",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunrise of Edmonds",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edmonds, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.