MEDICARE: SUNSET HOME

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	313M00000X	Nursing Facility/Intermediate Care Facility	0011643	IL
2	314000000X	Skilled Nursing Facility
3	314000000X	Skilled Nursing Facility	0011643	IL

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	:	1215937867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSET HOME

Provider Business Mailing Address
First Line	:	418 WASHINGTON ST
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-4862
Country	:	US
Telephone Number	:	217-223-2636
Fax Number	:	217-223-9867

Provider Business Practice Location Address
First Line	:	418 WASHINGTON ST
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-4862
Country	:	US
Telephone Number	:	217-223-2636
Fax Number	:	217-223-9867

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JONNI BULLINGTON
Credential	:	RN, LNHA
Telephone Number	:	217-223-2636

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	11/12/2024

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Directions to “SUNSET HOME ” Practice Location

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