Provider Demographics
NPI:1407221005
Name:SONSHINE ADULT DAY CARE SERVICES LLC
Entity Type:Organization
Organization Name:SONSHINE ADULT DAY CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUGUSTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-942-1703
Mailing Address - Street 1:8368 LATTY AVE
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-3236
Mailing Address - Country:US
Mailing Address - Phone:314-942-1703
Mailing Address - Fax:314-942-1703
Practice Address - Street 1:8368 LATTY AVE
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-3236
Practice Address - Country:US
Practice Address - Phone:314-942-1703
Practice Address - Fax:314-942-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1065261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care