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General NPI Number Information
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NPI Number | 1982184743
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Entity Type | Organization
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Legal Business Name | SUNSHINE 1 CONGREGATE HOME INC
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 1721 242ND ST
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City | LOMITA
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State | CA
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Zip | 90717-1306
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Country | US
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Telephone | 424-347-7065
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Fax | 424-347-7085
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Provider Business Mailing Address
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Address Line | 1721 242ND ST
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City | LOMITA
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State | CA
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Zip | 90717-1306
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Country | US
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Telephone | 424-347-7065
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Fax | 424-347-7085
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Authorized Official
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Title or Position | CEO
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Name | ILDIKO BROWN
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Credential |
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Telephone | 424-347-7065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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