MEDICARE: SUNSHINE CARE ASSISTED LIVING 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	AL12640	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AL12640	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1336533900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE CARE ASSISTED LIVING INC

Provider Business Mailing Address
First Line	:	9003 W CLUSTER AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2761
Country	:	US
Telephone Number	:	813-398-4428
Fax Number	:

Provider Business Practice Location Address
First Line	:	9003 W CLUSTER AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2761
Country	:	US
Telephone Number	:	813-398-4428
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	REGINO GARCIA
Credential	:
Telephone Number	:	813-398-4428

Provider Enumeration Date	:	03/22/2015
Last Update Date	:	03/22/2015

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