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General NPI Number Information
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NPI Number | 1518332071
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Entity Type | Organization
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Legal Business Name | SUN STATES SERVICES, INC
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 3000 GULF TO BAY BLVD SUITE 218
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City | CLEARWATER
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State | FL
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Zip | 33759-4321
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Country | US
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Telephone | 727-308-3831
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Fax | 727-314-4169
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Provider Business Mailing Address
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Address Line | 3000 GULF TO BAY BLVD SUITE 218
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City | CLEARWATER
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State | FL
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Zip | 33759-4321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NANCY FISHER
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Credential |
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Telephone | 225-931-8261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 20115096
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License Number State | FL
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