Healthcare Provider Details

I. General information

NPI: 1659412518
Provider Name (Legal Business Name): SUNSHINE TERRACE FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 W 300 N
LOGAN UT
84321-3810
US

IV. Provider business mailing address

209 W 300 N
LOGAN UT
84321-3809
US

V. Phone/Fax

Practice location:
  • Phone: 435-754-0246
  • Fax: 435-752-1318
Mailing address:
  • Phone: 435-754-0218
  • Fax: 435-754-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BRYAN ERICKSON
Title or Position: CEO
Credential:
Phone: 435-752-0411