Nic 4 Sunset Lake Leasing

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

9325 Issued in FL

Legal business name

NIC 4 SUNSET LAKE LEASING

Doing business as

Sunset Lake Village

Practice address

1121 Jacaranda Blvd.
Venice, FL 34292

Phone

(941) 497-1117

Fax

(941) 492-3455

NPI assigned

Apr 29, 2013

Last updated

Dec 1, 2016By 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

Jane Ryu

Title

President/Ceo/Cfo

Phone

(212) 479-5270

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sunset Lake Village Doing business as

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

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1285078659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "C/O HOLIDAY RETIREMENT, PO BOX 1700",
            "address_2": "NIC 4 SUNSET LAKE LEASING",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "97035",
            "telephone_number": "971-245-8020",
            "fax_number": "503-431-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 JACARANDA BLVD.",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "34292",
            "telephone_number": "941-497-1117",
            "fax_number": "941-492-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIC 4 SUNSET LAKE LEASING",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-29",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "RYU",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "PRESIDENT/CEO/CFO",
        "authorized_official_telephone_number": "212-479-5270"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "9325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID AGED/DISABLED ADULTS",
            "identifier": "003067300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunset Lake Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Venice, FL
• Providers in Venice, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; 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.