Provider Demographics
NPI:1114261518
Name:SUNSHINE MEADOWS ASSISTED LIVING FACILITY, INC.
Entity Type:Organization
Organization Name:SUNSHINE MEADOWS ASSISTED LIVING FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-906-9217
Mailing Address - Street 1:1809 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-7586
Mailing Address - Country:US
Mailing Address - Phone:941-906-9217
Mailing Address - Fax:941-906-8814
Practice Address - Street 1:1809 18TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-7586
Practice Address - Country:US
Practice Address - Phone:941-906-9217
Practice Address - Fax:941-906-8814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9060310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140833000Medicaid
FL675814200Medicaid