MEDICARE: SUNSHINE COMMUNITY HEALTH CENTER, 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	261QD0000X	Dental Clinic/Center	77895	AK

General Provider Information

NPI Number	:	1528463304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	24091 W LONG LAKE ROAD
Second Line	:
City	:	WILLOW
State	:	AK
Zip	:	99688-9999
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24091 W LONG LAKE RD
Second Line	:
City	:	WILLOW
State	:	AK
Zip	:	99688-0519
Country	:	US
Telephone Number	:	907-733-2273
Fax Number	:	907-733-1735

Authorized Official
Title or Position	:	CREDENTAILING SPECIALIST
Name	:	AMANDA SIMPSON
Credential	:
Telephone Number	:	907-733-2273

Provider Enumeration Date	:	10/23/2014
Last Update Date	:	12/03/2024

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