Healthcare Provider Details

I. General information

NPI: 1255168811
Provider Name (Legal Business Name): SUNSHINE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4694 W LOUISIANA AVE
SOPERTON GA
30457-2224
US

IV. Provider business mailing address

PO BOX 411
MOUNT VERNON GA
30445-0411
US

V. Phone/Fax

Practice location:
  • Phone: 912-529-5220
  • Fax: 877-912-3006
Mailing address:
  • Phone: 478-463-5812
  • Fax: 877-912-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JIMMIE SIE BLAND
Title or Position: PRESIDENT
Credential: MS, ATC
Phone: 478-463-5812