MEDICARE: SUNSHINE SENIOR ASSISTED LIVING

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1629250949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE SENIOR ASSISTED LIVING

Provider Business Mailing Address
First Line	:	4580 SW 33RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5504
Country	:	US
Telephone Number	:	954-805-4674
Fax Number	:

Provider Business Practice Location Address
First Line	:	4580 SW 33RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5504
Country	:	US
Telephone Number	:	954-805-4674
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. GRACE BROOKS
Credential	:
Telephone Number	:	954-805-4674

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	11/28/2007

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