Healthcare Provider Details

I. General information

NPI: 1114261518
Provider Name (Legal Business Name): SUNSHINE MEADOWS ASSISTED LIVING FACILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 18TH ST
SARASOTA FL
34234-7586
US

IV. Provider business mailing address

1809 18TH ST
SARASOTA FL
34234-7586
US

V. Phone/Fax

Practice location:
  • Phone: 941-906-9217
  • Fax: 941-906-8814
Mailing address:
  • Phone: 941-906-9217
  • Fax: 941-906-8814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL9060
License Number StateFL

VIII. Authorized Official

Name: MRS. VICKE MACK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 941-906-9217