MEDICARE: SONSHINE IN HOME CARE LLC

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	253Z00000X	In Home Supportive Care Agency		AL

General Provider Information

NPI Number	:	1255876553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONSHINE IN HOME CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 6631
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35813-0631
Country	:	US
Telephone Number	:	256-339-0855
Fax Number	:

Provider Business Practice Location Address
First Line	:	7734 MADISON BLVD STE 109
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-2379
Country	:	US
Telephone Number	:	256-693-3301
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MRS. SHELLY ANNE KURTZ
Credential	:	ADN
Telephone Number	:	256-339-0855

Provider Enumeration Date	:	12/23/2016
Last Update Date	:	12/23/2016

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