Provider Demographics
NPI:1417733171
Name:RAY OF SUNSHINE INDIVIDUAL SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:RAY OF SUNSHINE INDIVIDUAL SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-922-6423
Mailing Address - Street 1:636 MEADOWGREEN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-7221
Mailing Address - Country:US
Mailing Address - Phone:314-922-6423
Mailing Address - Fax:
Practice Address - Street 1:636 MEADOWGREEN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-7221
Practice Address - Country:US
Practice Address - Phone:314-922-6423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health