Sunnyside Manor Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

061329 Issued in NJ

Legal business name

SUNNYSIDE MANOR INC

Doing business as

Sunnyside Manor

Practice address

2500 Ridgewood Rd
Wall Township, NJ 07719-9600

Phone

(732) 528-9311

Fax

(732) 528-9026

NPI assigned

Jan 29, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Maryellen Keane, LNHA

Title

Administrator

Phone

(732) 528-9311

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Sunnyside Manor Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417093501. Details of each certification follow.

• CCN 315354 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 315354

Legal name

SUNNYSIDE MANOR INC

Doing business as

SUNNYSIDE MANOR

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 8, 1996

Last certification

May 16, 2024

Beds

60

Ownership / control type

Corporation

Organization structure

OtherProprietary

Incorporated

Dec 13, 1990 in NJ

Enrollment address

2500 Ridgewood Road
Sunnyside Manor
Wall, NJ 07719-9600

Nursing home name

SUNNYSIDE MANOR

Listed as

Sunnyside ManorCCN 315354 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

4 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

May 8, 1996

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

6057.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Tax ID family

Sunnyside Manor2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Sunnyside Manor Inc

  dba Sunnyside Manor

  • Assisted Living Facility
  • Wall Township, NJ
  • NPI 1750427282
  NPD tax ID

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeana Hansen

  • Nursing Facility/Intermediate Care Facility
  • Manasquan, NJ
  • NPI 1891125175
  NPD

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Harold Mark Cotler, D.O.

  • Family Medicine Physician
  • Wall Township, NJ
  • NPI 1659355832

  Nursing home

  Care Compare affiliation
• Suhas R Patel, M.D

  • Geriatric Medicine (Internal Medicine) Physician
  • Ocean, NJ
  • NPI 1104844778

  Nursing home

  Care Compare affiliation
• Maria G Pyontek, D.O.

  • Internal Medicine Physician
  • Wall, NJ
  • NPI 1336112390

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1417093501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 RIDGEWOOD RD",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077199600",
            "telephone_number": "732-528-9311",
            "fax_number": "732-528-9026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 RIDGEWOOD RD",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077199600",
            "telephone_number": "732-528-9311",
            "fax_number": "732-528-9026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 Ramshorn Dr",
            "address_purpose": "LOCATION",
            "city": "Manasquan",
            "state": "NJ",
            "postal_code": "087362133",
            "country_code": "US",
            "telephone_number": "732-528-9311",
            "fax_number": "732-528-9026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUNNYSIDE MANOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KEANE",
        "authorized_official_first_name": "MARYELLEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "732-528-9311",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "061329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE PROVIDER NUMBER",
            "identifier": "9652",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7902506",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunnyside Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Wall Township, NJ
• Providers in Wall Township, NJ by specialty
• Skilled Nursing Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.