MEDICARE: THE SUNSHINE INN, INC.

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	918	MS

General Provider Information

NPI Number	:	1326355694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SUNSHINE INN, INC.

Provider Business Mailing Address
First Line	:	1645 HIGHWAY 178 W
Second Line	:
City	:	MYRTLE
State	:	MS
Zip	:	38650-9690
Country	:	US
Telephone Number	:	662-988-3959
Fax Number	:	662-988-3989

Provider Business Practice Location Address
First Line	:	1645 HIGHWAY 178 W
Second Line	:
City	:	MYRTLE
State	:	MS
Zip	:	38650-9690
Country	:	US
Telephone Number	:	662-988-3959
Fax Number	:	662-988-3989

Authorized Official
Title or Position	:	LPN/ADMINISTRATOR
Name	:	MRS. LISA TAYLOR GALLOWAY
Credential	:
Telephone Number	:	662-988-3959

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/08/2010

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Directions to “THE SUNSHINE INN, INC. ” Practice Location

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