Healthcare Provider Details

I. General information

NPI: 1356546220
Provider Name (Legal Business Name): SUNFLOWER GARDENS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 S GREENVILLE ST
SANTA ANA CA
92704-7092
US

IV. Provider business mailing address

78 CENTENNIAL LOOP
EUGENE OR
97401-7900
US

V. Phone/Fax

Practice location:
  • Phone: 714-641-0959
  • Fax: 714-641-0956
Mailing address:
  • Phone: 541-747-3373
  • Fax: 541-747-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN HOLTZ
Title or Position: CONTROLLER
Credential:
Phone: 541-747-3373