Healthcare Provider Details

I. General information

NPI: 1447863923
Provider Name (Legal Business Name): SUNSHINE COMMUNITY HEALTH AND WELLNESS OUTREACH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 W VIRGINIA AVE NE
WASHINGTON DC
20002-1827
US

IV. Provider business mailing address

1100 48TH PL NE
WASHINGTON DC
20019-3914
US

V. Phone/Fax

Practice location:
  • Phone: 202-878-6128
  • Fax: 202-878-6102
Mailing address:
  • Phone: 202-905-7581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. NIA S EATMON
Title or Position: CEO
Credential: RN
Phone: 202-878-6128