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General NPI Number Information
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NPI Number | 1003702929
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Entity Type | Organization
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Legal Business Name | SUNSHINE SUPPORTIVE SERVICES
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 3207 67TH AVE N
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-1823
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Country | US
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Telephone | 612-590-0154
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Fax |
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Provider Business Mailing Address
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Address Line | 17119 72ND AVE N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-4565
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Country | US
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Telephone | 612-590-0154
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | ELIJAH GEORGE NYAMBANE
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Credential |
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Telephone | 612-590-0154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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