Provider Demographics
NPI:1518677632
Name:SUNFLOWER HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUNFLOWER HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAVARIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-613-8117
Mailing Address - Street 1:137 APPLE TREE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-1156
Mailing Address - Country:US
Mailing Address - Phone:501-613-8117
Mailing Address - Fax:
Practice Address - Street 1:14804 N CAVE CREEK RD STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4945
Practice Address - Country:US
Practice Address - Phone:501-613-8117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service