Healthcare Provider Details

I. General information

NPI: 1902018856
Provider Name (Legal Business Name): SUN LIFE FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 W AMERICAN AVE
ORACLE AZ
85623-6089
US

IV. Provider business mailing address

PO BOX 10097
CASA GRANDE AZ
85130-0020
US

V. Phone/Fax

Practice location:
  • Phone: 520-896-2092
  • Fax: 520-896-2449
Mailing address:
  • Phone: 520-836-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberOTC-3743
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierZFQ61788
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerMEDICARE OSCAR/CERTIFICATION
# 2
Identifier031871
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICARE
# 3
IdentifierZFQ61788
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICARE

VIII. Authorized Official

Name: KATE TURVIN
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 520-381-0383