Healthcare Provider Details

I. General information

NPI: 1639352727
Provider Name (Legal Business Name): SUNSHINE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W CARMEN AVE #307
CHICAGO IL
60640-3261
US

IV. Provider business mailing address

915 W CARMEN AVE #307
CHICAGO IL
60640-3261
US

V. Phone/Fax

Practice location:
  • Phone: 773-784-6378
  • Fax:
Mailing address:
  • Phone: 773-784-6378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number149.012666
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number149.012666
License Number StateIL

VIII. Authorized Official

Name: MR. ALDO HERNANDEZ
Title or Position: OWNER
Credential: LCSW
Phone: 773-784-6378