Healthcare Provider Details

I. General information

NPI: 1528463304
Provider Name (Legal Business Name): SUNSHINE COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24091 W LONG LAKE RD
WILLOW AK
99688-0519
US

IV. Provider business mailing address

24091 W LONG LAKE ROAD
WILLOW AK
99688-9999
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number77895
License Number StateAK

VIII. Authorized Official

Name: AMANDA SIMPSON
Title or Position: CREDENTAILING SPECIALIST
Credential:
Phone: 907-733-2273