MEDICARE: GGE ENTERPRISES LLC SUNSHINE CARE HOME I&II

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	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1770133118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GGE ENTERPRISES LLC SUNSHINE CARE HOME I&II

Provider Business Mailing Address
First Line	:	3045 S TIOGA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3218
Country	:	US
Telephone Number	:	224-716-1659
Fax Number	:

Provider Business Practice Location Address
First Line	:	3970 MARYLAND AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4559
Country	:	US
Telephone Number	:	702-914-9858
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARIA CECILIA EMELO
Credential	:
Telephone Number	:	224-716-1659

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	09/18/2019

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