Sunrise Village Care LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

PCH008698 Issued in GA

Legal business name

SUNRISE VILLAGE CARE LLC

Practice address

573 Pioneer Rd
Jasper, GA 30143-1225

Phone

(706) 253-0043

Fax

(770) 735-2661

NPI assigned

Jun 8, 2018

Last updated

Mar 11, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tammy Lynn Crider

Title

Administrator

Phone

(706) 299-3540

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1235622820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 SALEM CHURCH RD",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301435288",
            "telephone_number": "770-735-2219",
            "fax_number": "770-735-2661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "573 PIONEER RD",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301431225",
            "telephone_number": "706-253-0043",
            "fax_number": "770-735-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNRISE VILLAGE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-08",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A",
        "authorized_official_last_name": "CRIDER",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-299-3540"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "PCH008698",
            "primary": true
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holli Stephens
• Rachel Paige Stephens, PA-C
• Lucille Alyse Stout
• Tonia Payne Stout, M.A.
• Shea R Stromberg, AU.D.- CCC-A/FAAA
• Mark Andrew Supan, M.D.
• Lori Camille Swann, NP
• Ryan Swartz, LPC
• Jordan Lee Tate, M.D., MPH
• Brooke B. Teal, PA-C

• Assisted Living Facility in Jasper, GA
• Providers in Jasper, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.