Provider Demographics
NPI:1003380882
Name:SUNSHINE INC. RESIDENTIAL AND SUPPORT SERVICES
Entity Type:Organization
Organization Name:SUNSHINE INC. RESIDENTIAL AND SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-794-1371
Mailing Address - Street 1:7223 MAUMEE WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:403 ALLEN ST
Practice Address - Street 2:
Practice Address - City:WALBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43465-1232
Practice Address - Country:US
Practice Address - Phone:419-865-0251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities