MEDICARE: SUNSHINE VILLA HOMES 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

General Provider Information

NPI Number	:	1639554488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE VILLA HOMES LLC

Provider Business Mailing Address
First Line	:	1515 E MALONE AVE
Second Line	:
City	:	SIKESTON
State	:	MO
Zip	:	63801-3413
Country	:	US
Telephone Number	:	573-471-0466
Fax Number	:	573-471-4918

Provider Business Practice Location Address
First Line	:	2520 JAMES ST
Second Line	:
City	:	SCOTT CITY
State	:	MO
Zip	:	63780-1219
Country	:	US
Telephone Number	:	573-264-2424
Fax Number	:	573-471-4918

Authorized Official
Title or Position	:	OWNER
Name	:	TERRY R COLE
Credential	:
Telephone Number	:	573-380-4113

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	07/22/2015

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Directions to “SUNSHINE VILLA HOMES LLC ” Practice Location

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