MEDICARE: SUNSHINE CARE HOME 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1811723935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE CARE HOME LLC

Provider Business Mailing Address
First Line	:	3970 MARYLAND AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4559
Country	:	US
Telephone Number	:	725-309-7083
Fax Number	:	725-204-7272

Provider Business Practice Location Address
First Line	:	3970 MARYLAND AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4559
Country	:	US
Telephone Number	:	725-309-7083
Fax Number	:	725-204-7272

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JOYCE ANN MARIE MEDINA
Credential	:
Telephone Number	:	702-237-3395

Provider Enumeration Date	:	09/13/2024
Last Update Date	:	09/13/2024

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