Healthcare Provider Details

I. General information

NPI: 1326713082
Provider Name (Legal Business Name): SUNSHINE LIVING HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6413 SHASTA TRL
FORT WORTH TX
76133-4432
US

IV. Provider business mailing address

6413 SHASTA TRL
FORT WORTH TX
76133-4432
US

V. Phone/Fax

Practice location:
  • Phone: 817-966-7656
  • Fax:
Mailing address:
  • Phone: 817-966-7656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CANDICE BRENDA WILLIAMS
Title or Position: DIRECTOR
Credential: MS
Phone: 817-966-7656