Healthcare Provider Details

I. General information

NPI: 1699037101
Provider Name (Legal Business Name): SUNSHINE HAVEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 W LAKESIDE BLVD
OLMITO TX
78575-9767
US

IV. Provider business mailing address

PO BOX 4478
BROWNSVILLE TX
78523-4478
US

V. Phone/Fax

Practice location:
  • Phone: 956-350-8400
  • Fax: 956-350-8089
Mailing address:
  • Phone: 956-350-8400
  • Fax: 956-350-8089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number25
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number25
License Number StateTX

VIII. Authorized Official

Name: MS. ELIZABETH P SHULL
Title or Position: EXECUTIVE DIRECTOR
Credential: M.ED.
Phone: 956-350-8400