Provider Demographics
NPI:1508926221
Name:NORTH SUNFLOWER MEDICAL CENTER HHA
Entity Type:Organization
Organization Name:NORTH SUNFLOWER MEDICAL CENTER HHA
Other - Org Name:SUNFLOWER HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-756-2711
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:840 NORTH OAK
Mailing Address - City:RULEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38771-0369
Mailing Address - Country:US
Mailing Address - Phone:662-756-4676
Mailing Address - Fax:662-756-2009
Practice Address - Street 1:840 N OAK AVE
Practice Address - Street 2:
Practice Address - City:RULEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38771-3227
Practice Address - Country:US
Practice Address - Phone:662-756-4676
Practice Address - Fax:662-756-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS8581251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00070518Medicaid
MS000070109OtherBLUE CROSS BLUE SHIELD
MS=========007OtherTRICARE
MS=========005OtherTRICARE
MS000070109OtherBLUE CROSS BLUE SHIELD
MS=========005OtherTRICARE
MS257016Medicare ID - Type Unspecified