Healthcare Provider Details

I. General information

NPI: 1982184743
Provider Name (Legal Business Name): SUNSHINE 1 CONGREGATE HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 242ND ST
LOMITA CA
90717-1306
US

IV. Provider business mailing address

1721 242ND ST
LOMITA CA
90717-1306
US

V. Phone/Fax

Practice location:
  • Phone: 424-347-7065
  • Fax: 424-347-7085
Mailing address:
  • Phone: 424-347-7065
  • Fax: 424-347-7085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ILDIKO BROWN
Title or Position: CEO
Credential:
Phone: 424-347-7065