Provider Demographics
NPI:1508034117
Name:SUNSHINE ADULT DAY CARE FACILITY
Entity Type:Organization
Organization Name:SUNSHINE ADULT DAY CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-398-9800
Mailing Address - Street 1:6207 N LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2817
Mailing Address - Country:US
Mailing Address - Phone:314-731-8087
Mailing Address - Fax:314-731-8079
Practice Address - Street 1:6207 N LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2817
Practice Address - Country:US
Practice Address - Phone:314-731-8087
Practice Address - Fax:314-731-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO746251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization