MEDICARE: JOHN'S SUNSHINE HAVEN, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1649155284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN'S SUNSHINE HAVEN, LLC

Provider Business Mailing Address
First Line	:	537 W SUGAR CREEK RD STE 202
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-6102
Country	:	US
Telephone Number	:	704-231-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	9620 BAYVIEW PKWY STE 202
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-3722
Country	:	US
Telephone Number	:	704-231-5299
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	KIMBERLY L RUSHING
Credential	:
Telephone Number	:	704-231-5299

Provider Enumeration Date	:	08/11/2025
Last Update Date	:	08/13/2025

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