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General NPI Number Information
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NPI Number | 1053869818
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Entity Type | Organization
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Legal Business Name | A RAY OF SUNSHINE
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 216 CHICKAMAUGA LN
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City | SIMPSONVILLE
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State | SC
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Zip | 29681
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Country | US
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Telephone | 864-381-4227
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Fax |
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Provider Business Mailing Address
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Address Line | 216 CHICKAMAUGA LN
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City | SIMPSONVILLE
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State | SC
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Zip | 29681
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Country | US
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Telephone | 864-381-4227
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Fax |
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Authorized Official
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Title or Position | CNA
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Name | ANTONIO ALLEN
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Credential |
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Telephone | 864-381-4227
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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 | 24708
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License Number State | SC
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