=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285798082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J H FLOYD SUNSHINE MANOR INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 04/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1755 18TH ST
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34234-8657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-955-4915
-----------------------------------------------------
Fax | 941-366-9455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1755 18TH ST
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34234-8657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-955-4915
-----------------------------------------------------
Fax | 941-366-9455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIR OR ACCOUNTING
-----------------------------------------------------
Name | MS. TRINA FISK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-723-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | SNF12510961
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------