Provider Demographics
NPI:1164549861
Name:SUNSHINE COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SUNSHINE COMMUNITY HEALTH CENTER
Other - Org Name:SUNSHINE CARE CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-733-9207
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:TALKEETNA
Mailing Address - State:AK
Mailing Address - Zip Code:99676-0787
Mailing Address - Country:US
Mailing Address - Phone:907-733-9207
Mailing Address - Fax:907-733-1735
Practice Address - Street 1:MILE 4.5 TALKEETNA SPUR ROAD
Practice Address - Street 2:
Practice Address - City:TALKEETNA
Practice Address - State:AK
Practice Address - Zip Code:99676
Practice Address - Country:US
Practice Address - Phone:907-733-2273
Practice Address - Fax:907-733-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK77895251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG3761Medicaid