Healthcare Provider Details

I. General information

NPI: 1467158766
Provider Name (Legal Business Name): SUNSHINE HOMECARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 W SAINT CATHERINE AVE
PHOENIX AZ
85041-5859
US

IV. Provider business mailing address

4240 S ARIZONA AVE STE 1099
CHANDLER AZ
85248-4593
US

V. Phone/Fax

Practice location:
  • Phone: 469-380-8985
  • Fax:
Mailing address:
  • Phone: 928-877-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: FATIMA THOMPSON
Title or Position: OWNER
Credential:
Phone: 928-877-2525