Healthcare Provider Details

I. General information

NPI: 1033989710
Provider Name (Legal Business Name): SUNSHINE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 16TH AVE S
FARGO ND
58103-4162
US

IV. Provider business mailing address

PO BOX 94
TWIN VALLEY MN
56584-0094
US

V. Phone/Fax

Practice location:
  • Phone: 218-415-0688
  • Fax: 888-212-0036
Mailing address:
  • Phone: 218-415-0688
  • Fax: 888-212-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE HELM
Title or Position: OWNER
Credential:
Phone: 218-415-0688