Healthcare Provider Details

I. General information

NPI: 1104996636
Provider Name (Legal Business Name): SUNSHINE MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 RIO VISTA CT
SPRING HILL FL
34608-8497
US

IV. Provider business mailing address

451 RIO VISTA CT
SPRING HILL FL
34608-8497
US

V. Phone/Fax

Practice location:
  • Phone: 352-684-1550
  • Fax: 352-684-7202
Mailing address:
  • Phone: 352-684-1550
  • Fax: 352-684-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number678706196
License Number StateFL

VIII. Authorized Official

Name: MR. SAMUEL GILES
Title or Position: PROVIDER
Credential:
Phone: 352-684-1550