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General NPI Number Information
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NPI Number | 1104996636
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Entity Type | Organization
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Legal Business Name | SUNSHINE MANOR
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 11/20/2008
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Provider Practice Location Address
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Address Line | 451 RIO VISTA CT
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City | SPRING HILL
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State | FL
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Zip | 34608-8497
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Country | US
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Telephone | 352-684-1550
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Fax | 352-684-7202
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Provider Business Mailing Address
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Address Line | 451 RIO VISTA CT
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City | SPRING HILL
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State | FL
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Zip | 34608-8497
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Country | US
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Telephone | 352-684-1550
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Fax | 352-684-7202
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Authorized Official
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Title or Position | PROVIDER
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Name | MR. SAMUEL GILES
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Credential |
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Telephone | 352-684-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 678706196
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License Number State | FL
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