Healthcare Provider Details

I. General information

NPI: 1972046373
Provider Name (Legal Business Name): SUNSHINESMILE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19800 SW 110TH CT UNIT. 209 B
CUTLER BAY FL
33157-8430
US

IV. Provider business mailing address

19800 SW 110TH CT UNIT. 209 B
CUTLER BAY FL
33157-8430
US

V. Phone/Fax

Practice location:
  • Phone: 786-294-1100
  • Fax: 305-971-9076
Mailing address:
  • Phone: 786-294-1100
  • Fax: 305-971-9076

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANN THOMPSON
Title or Position: OWNER
Credential:
Phone: 786-294-1100