Provider Demographics
NPI:1235610551
Name:LILIBETH SWANSON
Entity Type:Organization
Organization Name:LILIBETH SWANSON
Other - Org Name:SUNSHINE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LILIBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-806-9914
Mailing Address - Street 1:720 N LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4635
Mailing Address - Country:US
Mailing Address - Phone:909-806-9914
Mailing Address - Fax:
Practice Address - Street 1:720 N LINDEN AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4635
Practice Address - Country:US
Practice Address - Phone:909-806-9914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36642645177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA366426645OtherHOME CARE LICENSE