Healthcare Provider Details

I. General information

NPI: 1275143786
Provider Name (Legal Business Name): SUNSHINE CARE SUPPORT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NOTRE DAME DR
ALTAMONTE SPRINGS FL
32714-4119
US

IV. Provider business mailing address

PO BOX 580161
ORLANDO FL
32858-0161
US

V. Phone/Fax

Practice location:
  • Phone: 321-594-9656
  • Fax:
Mailing address:
  • Phone: 321-594-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHENEITA KELLY
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 321-594-9656