Healthcare Provider Details

I. General information

NPI: 1326336892
Provider Name (Legal Business Name): SUNSHINE TERRACE FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N 200 W
LOGAN UT
84321
US

IV. Provider business mailing address

209 W 300 N
LOGAN UT
84321
US

V. Phone/Fax

Practice location:
  • Phone: 435-716-8541
  • Fax: 435-716-8537
Mailing address:
  • Phone: 435-752-0411
  • Fax: 435-716-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. DENNIS WIDLMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-716-8541