Healthcare Provider Details

I. General information

NPI: 1902429772
Provider Name (Legal Business Name): SUNSHINE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1566 UNION RD STE B
GASTONIA NC
28054-5301
US

IV. Provider business mailing address

227 W 4TH ST
CHARLOTTE NC
28202-1545
US

V. Phone/Fax

Practice location:
  • Phone: 864-509-8550
  • Fax: 800-239-1496
Mailing address:
  • Phone: 864-509-8550
  • Fax: 800-239-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: PARANDA DAVIS DAVIS
Title or Position: PRESIDENT
Credential:
Phone: 980-200-3706