=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356693113
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOU ARE MY SUNSHINE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2012
-----------------------------------------------------
Last Update Date | 10/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29789 FAIRFAX ST
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48076-2232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-460-6240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29789 FAIRFAX ST
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48076-2232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-460-6240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/NURSING ASSISTANT
-----------------------------------------------------
Name | CATHERINE SCOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-460-6240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | D8195M
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------