MEDICARE: SUNSHINE COUNSELING SERVICES

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	314000000X	Skilled Nursing Facility	149.012666	IL
2	311ZA0620X	Adult Care Home Facility	149.012666	IL

General Provider Information

NPI Number	:	1639352727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	915 W CARMEN AVE
Second Line	:	#307
City	:	CHICAGO
State	:	IL
Zip	:	60640-3261
Country	:	US
Telephone Number	:	773-784-6378
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 W CARMEN AVE
Second Line	:	#307
City	:	CHICAGO
State	:	IL
Zip	:	60640-3261
Country	:	US
Telephone Number	:	773-784-6378
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ALDO HERNANDEZ
Credential	:	LCSW
Telephone Number	:	773-784-6378

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	06/30/2009

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Directions to “SUNSHINE COUNSELING SERVICES ” Practice Location

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