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General NPI Number Information
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NPI Number | 1407954308
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Entity Type | Organization
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Legal Business Name | SUNSHINE HOSPICE, INC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 106 E MAIN ST
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City | TISHOMINGO
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State | OK
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Zip | 73460-2338
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Country | US
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Telephone | 580-371-3281
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Fax | 580-371-3283
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Provider Business Mailing Address
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Address Line | 1100 NE LINCOLN RD SUITE D
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City | IDABEL
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State | OK
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Zip | 74745-2412
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Country | US
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Telephone | 580-208-2273
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Fax | 580-208-2271
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. REX DONALDSON
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Credential |
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Telephone | 580-208-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 371615
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License Number State | OK
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