Sunrise Second Assisted Living Holdings, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

5101297 Issued in IL

Legal business name

SUNRISE SECOND ASSISTED LIVING HOLDINGS, LLC

Practice address

12828 S la Grange Rd
Palos Park, IL 60464-2247

Phone

(708) 361-3577

NPI assigned

Jun 5, 2007

Last updated

Aug 22, 2020By 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

Kathleen Roelofs

Title

Executive Director

Phone

(708) 361-3577

Specialties & licenses 1

Addresses

Other names 1

• Sunrise of Palos Park Other name

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396947826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12828 S LA GRANGE RD",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604642247",
            "telephone_number": "708-361-3577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12828 S LA GRANGE RD",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604642247",
            "telephone_number": "708-361-3577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNRISE SECOND ASSISTED LIVING HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROELOFS",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "708-361-3577"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IL",
            "license": "5101297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunrise of Palos Park",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mariyan Kosev Stoykov
• Elizabeth Courtney Stringer, M.D.
• Deborah Marie Stukus
• Sheila Stull
• Jaclyn Ann Sullivan
• Sym Palos Park SNF Healthcare LLC
• The Balanced Dietitian LLC
• Dwonna Denise Thompson, MA, LCPC
• Wayne A Tillman, DPM
• Elton Toledo, PTA

• Assisted Living Facility in Palos Park, IL
• Providers in Palos Park, IL by specialty
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.