MEDICARE: SUNSHINE ASSISTED LIVING HOME II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	100937	AK

General Provider Information

NPI Number	:	1033485099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE ASSISTED LIVING HOME II

Provider Business Mailing Address
First Line	:	8037 COUNTRY WOODS DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-4691
Country	:	US
Telephone Number	:	907-947-6262
Fax Number	:	907-522-5322

Provider Business Practice Location Address
First Line	:	6261 COLLINS WAY
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-2147
Country	:	US
Telephone Number	:	907-868-1229
Fax Number	:	907-522-5322

Authorized Official
Title or Position	:	OWNER
Name	:	FERDIE TAN ODRON
Credential	:
Telephone Number	:	907-947-6262

Provider Enumeration Date	:	03/23/2012
Last Update Date	:	03/23/2012

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