MEDICARE: HOLMAN-HAMPTON SUNSHINE FAMILY CARE HOME

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	FCL079-063	NC

General Provider Information

NPI Number	:	1912133059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLMAN-HAMPTON SUNSHINE FAMILY CARE HOME

Provider Business Mailing Address
First Line	:	1031 SHARPE AVE
Second Line	:	HOUSE #2
City	:	EDEN
State	:	NC
Zip	:	27288-3729
Country	:	US
Telephone Number	:	336-589-0239
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 GLENDALE DR.
Second Line	:
City	:	EDEN
State	:	NC
Zip	:	27288-0000
Country	:	US
Telephone Number	:	336-589-0239
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT / ADMINISTRATOR
Name	:	JANE LEVETTE HAMPTON
Credential	:
Telephone Number	:	336-589-0239

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	06/03/2009

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