Provider Demographics
NPI:1518332071
Name:SUN STATES SERVICES, INC
Entity Type:Organization
Organization Name:SUN STATES SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-931-8261
Mailing Address - Street 1:3000 GULF TO BAY BLVD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-4321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 GULF TO BAY BLVD
Practice Address - Street 2:SUITE 218
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4321
Practice Address - Country:US
Practice Address - Phone:727-308-3831
Practice Address - Fax:727-314-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20115096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20115096OtherAPPLYING FOR MEDICARE LICENSE