MEDICARE: SUNSHINE MANOR, 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	314000000X	Skilled Nursing Facility	037234	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659368124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE MANOR, LLC

Provider Business Mailing Address
First Line	:	894 LELAND AVE
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-3239
Country	:	US
Telephone Number	:	314-726-4767
Fax Number	:	314-726-1308

Provider Business Practice Location Address
First Line	:	894 LELAND AVE
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-3239
Country	:	US
Telephone Number	:	314-726-4767
Fax Number	:	314-726-1308

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. SHARO SHIRSHEKAN
Credential	:
Telephone Number	:	573-701-0600

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	03/16/2010

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Directions to “SUNSHINE MANOR, LLC ” Practice Location

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