MEDICARE: SUNSHINES HOMEMAKER AND COMPANION SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174200000X	Meals Provider
2	251E00000X	Home Health Agency
3	253Z00000X	In Home Supportive Care Agency
4	347C00000X	Private Vehicle
5	372600000X	Adult Companion	235064	FL

General Provider Information

NPI Number	:	1053827279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINES HOMEMAKER AND COMPANION SERVICES LLC

Provider Business Mailing Address
First Line	:	1535 SW HUNNICUT AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-7007
Country	:	US
Telephone Number	:	561-306-9275
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 SW HUNNICUT AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-7007
Country	:	US
Telephone Number	:	561-306-9275
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LETICIA KELLY
Credential	:	CNA
Telephone Number	:	561-306-9275

Provider Enumeration Date	:	12/26/2017
Last Update Date	:	01/22/2021

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