Healthcare Provider Details

I. General information

NPI: 1922581685
Provider Name (Legal Business Name): SUNLIGHT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 VIRGINIA ST
SAINT PAUL MN
55103-2353
US

IV. Provider business mailing address

440 VIRGINIA ST
SAINT PAUL MN
55103-2353
US

V. Phone/Fax

Practice location:
  • Phone: 651-600-4403
  • Fax:
Mailing address:
  • Phone: 651-600-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: KER VUE
Title or Position: CEO
Credential:
Phone: 651-472-2109