Healthcare Provider Details

I. General information

NPI: 1851446009
Provider Name (Legal Business Name): SUNSHINE CHILDREN'S HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9215 COUNTY LANE 175
CARTHAGE MO
64836-8812
US

IV. Provider business mailing address

9215 COUNTY LANE 175 PO BOX 713
CARTHAGE MO
64836-8812
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-5722
  • Fax: 417-358-9676
Mailing address:
  • Phone: 417-358-5722
  • Fax: 417-358-9676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number0792471
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number0080322
License Number StateMO

VIII. Authorized Official

Name: MR. BILL YORK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 417-358-5722