Provider Demographics
NPI:1003702929
Name:SUNSHINE SUPPORTIVE SERVICES
Entity type:Organization
Organization Name:SUNSHINE SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:NYAMBANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-590-0154
Mailing Address - Street 1:17119 72ND AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-4565
Mailing Address - Country:US
Mailing Address - Phone:612-590-0154
Mailing Address - Fax:
Practice Address - Street 1:3207 67TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1823
Practice Address - Country:US
Practice Address - Phone:612-590-0154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility