Provider Demographics
NPI:1306192356
Name:SUNSHINE FOR LIFE LLC
Entity Type:Organization
Organization Name:SUNSHINE FOR LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELNORA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-326-3526
Mailing Address - Street 1:655 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28555-9121
Mailing Address - Country:US
Mailing Address - Phone:910-326-3526
Mailing Address - Fax:
Practice Address - Street 1:655 SMITH RD
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28555-9121
Practice Address - Country:US
Practice Address - Phone:910-326-3526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health