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General NPI Number Information
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NPI Number | 1851630883
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Entity Type | Organization
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Legal Business Name | SUNSET HOME
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Dates
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Enumeration Date | 02/12/2013
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 418 WASHINGTON ST
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City | QUINCY
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State | IL
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Zip | 62301-4862
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Country | US
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Telephone | 217-223-2636
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Fax | 217-223-9867
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Provider Business Mailing Address
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Address Line | 418 WASHINGTON ST
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City | QUINCY
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State | IL
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Zip | 62301-4862
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Country | US
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Telephone | 217-223-2636
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Fax | 217-223-9867
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Authorized Official
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Title or Position | ACCOUNTING DIRECTOR
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Name | MR. KELLEY HATFIELD
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Credential |
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Telephone | 217-223-2636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0011643
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License Number State | IL
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