Healthcare Provider Details

I. General information

NPI: 1760753818
Provider Name (Legal Business Name): SUNSHINE PCH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2012
Last Update Date: 01/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 E 40TH ST
SAVANNAH GA
31404-3408
US

IV. Provider business mailing address

1130 E 40TH ST
SAVANNAH GA
31404-3408
US

V. Phone/Fax

Practice location:
  • Phone: 912-236-8227
  • Fax:
Mailing address:
  • Phone: 912-236-8227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number025012391
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. DONNA STROMAN
Title or Position: OWNER
Credential:
Phone: 912-272-8417