MEDICARE: SUNSHINE MANOR

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1609132026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE MANOR

Provider Business Mailing Address
First Line	:	15015 OXNARD ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-2613
Country	:	US
Telephone Number	:	818-787-4151
Fax Number	:

Provider Business Practice Location Address
First Line	:	10540 SHERMAN GROVE AVE
Second Line	:
City	:	SUNLAND
State	:	CA
Zip	:	91040-1913
Country	:	US
Telephone Number	:	818-352-5941
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	ELIZABETH MACIAS
Credential	:
Telephone Number	:	818-787-4151

Provider Enumeration Date	:	04/10/2012
Last Update Date	:	06/07/2012

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Directions to “SUNSHINE MANOR ” Practice Location

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