Healthcare Provider Details

I. General information

NPI: 1003552373
Provider Name (Legal Business Name): SUNSHINE MINNIE GROUP HOMES CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 CORAL COVE DR
ORLANDO FL
32818-2849
US

IV. Provider business mailing address

6630 CORAL COVE DR
ORLANDO FL
32818-2849
US

V. Phone/Fax

Practice location:
  • Phone: 754-234-1590
  • Fax:
Mailing address:
  • Phone: 754-234-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MANOUCHECA AUGUSTIN
Title or Position: CEO
Credential:
Phone: 754-234-1590