MEDICARE: MORNING SUNSHINE CARE HOME 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1588446728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORNING SUNSHINE CARE HOME INC.

Provider Business Mailing Address
First Line	:	5516 AZUZA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-7121
Country	:	US
Telephone Number	:	808-388-6523
Fax Number	:

Provider Business Practice Location Address
First Line	:	5516 AZUZA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-7121
Country	:	US
Telephone Number	:	808-388-6523
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIVIC B. FIESTA
Credential	:
Telephone Number	:	808-388-6523

Provider Enumeration Date	:	10/20/2023
Last Update Date	:	10/20/2023

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