MEDICARE: THE SUNSHINE HOUSE OF HOUSTON

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1104343037	OTHER	TX	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1689183261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SUNSHINE HOUSE OF HOUSTON

Provider Business Mailing Address
First Line	:	5305 WILMINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-3256
Country	:	US
Telephone Number	:	346-240-4623
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 WILMINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-3256
Country	:	US
Telephone Number	:	346-240-4623
Fax Number	:	346-240-4623

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MRS. DOROTHY MAE CONLEY
Credential	:	RN
Telephone Number	:	409-771-2484

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	09/26/2017

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Directions to “THE SUNSHINE HOUSE OF HOUSTON ” Practice Location

Language	Start Address	Practice Location

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