Healthcare Provider Details

I. General information

NPI: 1598433005
Provider Name (Legal Business Name): SUNSHINE BEHAVIORAL HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13614 N 89TH ST
SCOTTSDALE AZ
85260-7653
US

IV. Provider business mailing address

13614 N 89TH ST
SCOTTSDALE AZ
85260-7653
US

V. Phone/Fax

Practice location:
  • Phone: 480-572-1850
  • Fax:
Mailing address:
  • Phone: 480-572-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JANETT AGBAYANI
Title or Position: CO-OWNER
Credential:
Phone: 623-565-1812