Provider Demographics
NPI:1063664746
Name:THEOPHILUS AGBUKE
Entity Type:Organization
Organization Name:THEOPHILUS AGBUKE
Other - Org Name:SUNSHINE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBUKE
Authorized Official - Suffix:
Authorized Official - Credentials:R,N
Authorized Official - Phone:210-804-1663
Mailing Address - Street 1:PO BOX 781686
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-1686
Mailing Address - Country:US
Mailing Address - Phone:210-804-1663
Mailing Address - Fax:210-804-1663
Practice Address - Street 1:2458 HARRY WURZBACH RD
Practice Address - Street 2:#2
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5002
Practice Address - Country:US
Practice Address - Phone:210-804-1663
Practice Address - Fax:210-804-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility