Healthcare Provider Details

I. General information

NPI: 1477841138
Provider Name (Legal Business Name): SUNSHINE ADULT ACTIVITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 INTERSTATE 30 STE C
MESQUITE TX
75150-2682
US

IV. Provider business mailing address

3605 INTERSTATE 30 STE C
MESQUITE TX
75150-2682
US

V. Phone/Fax

Practice location:
  • Phone: 972-686-7443
  • Fax: 972-686-7445
Mailing address:
  • Phone: 972-686-7443
  • Fax: 972-686-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: MS. AMIKA SHANELL PARKMAN
Title or Position: DIRECTOR
Credential:
Phone: 972-686-7443