Provider Demographics
NPI:1518231240
Name:SUNSHINE ADULT ACTIVITY CENTER
Entity Type:Organization
Organization Name:SUNSHINE ADULT ACTIVITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMIKA
Authorized Official - Middle Name:SHANELL
Authorized Official - Last Name:PARKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-686-7443
Mailing Address - Street 1:3605 INTERSTATE 30
Mailing Address - Street 2:SUITE C
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2670
Mailing Address - Country:US
Mailing Address - Phone:972-686-7443
Mailing Address - Fax:972-686-7445
Practice Address - Street 1:3605 INTERSTATE 30
Practice Address - Street 2:SUITE C
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2670
Practice Address - Country:US
Practice Address - Phone:972-686-7443
Practice Address - Fax:972-686-7445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNSHINE ADULT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133762311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)