MEDICARE: SUNSHINE INC. RESIDENTIAL AND SUPPORT SERVICES

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	251C00000X	Developmentally Disabled Services Day Training Agency		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124353909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE INC. RESIDENTIAL AND SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	7223 MAUMEE WESTERN RD
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-9755
Country	:	US
Telephone Number	:	419-865-0251
Fax Number	:	419-865-5607

Provider Business Practice Location Address
First Line	:	3211 KING RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-1407
Country	:	US
Telephone Number	:	419-865-0251
Fax Number	:	419-865-5607

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR OF FINANCE
Name	:	MRS. RHONDA HELEN REGENT
Credential	:
Telephone Number	:	419-794-1371

Provider Enumeration Date	:	10/12/2009
Last Update Date	:	10/12/2009

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