Healthcare Provider Details

I. General information

NPI: 1124079751
Provider Name (Legal Business Name): SUNSHINE ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506B S DUNCAN BYP
UNION SC
29379-7219
US

IV. Provider business mailing address

506B S DUNCAN BYP
UNION SC
29379-7219
US

V. Phone/Fax

Practice location:
  • Phone: 864-429-0505
  • Fax: 864-429-8578
Mailing address:
  • Phone: 864-429-0505
  • Fax: 864-429-8578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC-251
License Number StateSC

VIII. Authorized Official

Name: SHERRI BATES PUCKETT
Title or Position: DIRECTOR
Credential:
Phone: 864-429-0505