=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124044276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSHINE HOME CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 02/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5411 W ADDISON ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60641-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-456-3055
-----------------------------------------------------
Fax | 708-456-3319
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5411 W ADDISON ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60641-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-456-3055
-----------------------------------------------------
Fax | 708-456-3319
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GEN.MANAGER/OWNER
-----------------------------------------------------
Name | CHRISTINE YU
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 708-456-3055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1010246
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------