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General NPI Number Information
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NPI Number | 1619842135
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Entity Type | Organization
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Legal Business Name | SUNNYSIDE AFH CARE LLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 4393 INDIGO ST NE
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City | SALEM
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State | OR
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Zip | 97305-2137
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Country | US
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Telephone | 503-510-7236
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Fax | 503-966-3990
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Provider Business Mailing Address
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Address Line | 4393 INDIGO ST NE
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City | SALEM
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State | OR
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Zip | 97305-2137
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Country | US
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Telephone | 503-510-7236
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Fax | 503-966-3990
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CHARLES MAINA KIMANI
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Credential |
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Telephone | 503-510-7236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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