Healthcare Provider Details

I. General information

NPI: 1922071117
Provider Name (Legal Business Name): SUNSHINE COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35300 S TALKEETNA SPUR RD
TALKEETNA AK
99676
US

IV. Provider business mailing address

HC 89 BOX 8190
TALKEETNA AK
99676-9701
US

V. Phone/Fax

Practice location:
  • Phone: 907-733-2273
  • Fax: 907-733-1735
Mailing address:
  • Phone: 907-733-2273
  • Fax: 907-733-1735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number77895
License Number StateAK

VIII. Authorized Official

Name: MELODY PALERMO
Title or Position: CEO
Credential:
Phone: 907-733-2273