MEDICARE: SUNSHINE FAMILY ALF, 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	310400000X	Assisted Living Facility	12924	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568908259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE FAMILY ALF, LLC

Provider Business Mailing Address
First Line	:	5817 NW GERALD CIR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-4168
Country	:	US
Telephone Number	:	772-301-4508
Fax Number	:

Provider Business Practice Location Address
First Line	:	5817 NW GERALD CIR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-4168
Country	:	US
Telephone Number	:	772-301-4508
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	ALICE PAUL
Credential	:
Telephone Number	:	772-924-6708

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	01/18/2017

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