=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558014795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUN VALLEY HOME HEALTH & PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2022
-----------------------------------------------------
Last Update Date | 01/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 156 W AVENUE A
-----------------------------------------------------
City | BELLE GLADE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33430-3018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-983-8758
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 156 W AVENUE A
-----------------------------------------------------
City | BELLE GLADE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33430-3018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-983-8758
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MGR
-----------------------------------------------------
Name | MRS. MARIE G MENGUAL JOSEPH
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 561-574-3165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------