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General NPI Number Information
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NPI Number | 1518231240
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Entity Type | Organization
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Legal Business Name | SUNSHINE ADULT ACTIVITY CENTER
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 3605 INTERSTATE 30 SUITE C
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City | MESQUITE
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State | TX
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Zip | 75150-2670
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Country | US
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Telephone | 972-686-7443
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Fax | 972-686-7445
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Provider Business Mailing Address
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Address Line | 3605 INTERSTATE 30 SUITE C
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City | MESQUITE
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State | TX
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Zip | 75150-2670
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Country | US
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Telephone | 972-686-7443
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Fax | 972-686-7445
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. AMIKA SHANELL PARKMAN
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Credential |
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Telephone | 972-686-7443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 133762
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License Number State | TX
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