Healthcare Provider Details

I. General information

NPI: 1700186061
Provider Name (Legal Business Name): SUNSHINE THERAPY CLUB II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TOWNSHIP LINE RD SUITE 102
DREXEL HILL PA
19026-1925
US

IV. Provider business mailing address

3300 TOWNSHIP LINE RD SUITE 102
DREXEL HILL PA
19026-1925
US

V. Phone/Fax

Practice location:
  • Phone: 610-853-9919
  • Fax: 610-853-9921
Mailing address:
  • Phone: 610-853-9919
  • Fax: 610-853-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TARAYA J SHIRDAN
Title or Position: EXECUTIVE DIRECTOR
Credential: LPT
Phone: 610-853-9919