Provider Demographics
NPI:1407954308
Name:SUNSHINE HOSPICE, INC
Entity Type:Organization
Organization Name:SUNSHINE HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-208-2273
Mailing Address - Street 1:1100 NE LINCOLN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-2412
Mailing Address - Country:US
Mailing Address - Phone:580-208-2273
Mailing Address - Fax:580-208-2271
Practice Address - Street 1:106 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-2338
Practice Address - Country:US
Practice Address - Phone:580-371-3281
Practice Address - Fax:580-371-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK371615251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371615Medicare ID - Type UnspecifiedHOSPICE