Provider Demographics
NPI:1043704612
Name:SUNSHINE PREMIER HOME HEALTH AGENCY, LLC
Entity Type:Organization
Organization Name:SUNSHINE PREMIER HOME HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MANDVIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LORISTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-730-2459
Mailing Address - Street 1:PO BOX 784472
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34778-4472
Mailing Address - Country:US
Mailing Address - Phone:407-730-2459
Mailing Address - Fax:
Practice Address - Street 1:2710 S ORANGE BLOSSOM TRL STE 1/2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-6168
Practice Address - Country:US
Practice Address - Phone:407-949-2590
Practice Address - Fax:407-270-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health