=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275808859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNNY DAYS ADULT CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2012
-----------------------------------------------------
Last Update Date | 06/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1767 ORCHID CT NW
-----------------------------------------------------
City | PALM BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32907-6985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-460-4882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1767 ORCHID CT NW
-----------------------------------------------------
City | PALM BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32907-6985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-460-4882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. JACQUELINE ANDREA FLETCHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-460-4882
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL12027
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------