Healthcare Provider Details

I. General information

NPI: 1629669916
Provider Name (Legal Business Name): SUNSHINE GARDENS NURSING & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 COMFORT DR
MARION IL
62959-4927
US

IV. Provider business mailing address

442 COMFORT DR
MARION IL
62959-4927
US

V. Phone/Fax

Practice location:
  • Phone: 618-364-0482
  • Fax:
Mailing address:
  • Phone: 618-364-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SRINIVAS GUNDALA
Title or Position: CEO
Credential:
Phone: 618-364-0482