Provider Demographics
NPI:1306000856
Name:SUNSHINE TERRACE FOUNDATION, INC
Entity Type:Organization
Organization Name:SUNSHINE TERRACE FOUNDATION, INC
Other - Org Name:SUNSHINE TERRACE OUTPATIENT THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-716-8553
Mailing Address - Street 1:209 W 300 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-3809
Mailing Address - Country:US
Mailing Address - Phone:435-716-8535
Mailing Address - Fax:435-716-8558
Practice Address - Street 1:209 W 300 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-3809
Practice Address - Country:US
Practice Address - Phone:435-716-8535
Practice Address - Fax:435-716-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000064576Medicare UPIN