Provider Demographics
NPI:1558395764
Name:SUNFLOWER PARK HEALTH CARE PROVIDERS LP
Entity Type:Organization
Organization Name:SUNFLOWER PARK HEALTH CARE PROVIDERS LP
Other - Org Name:SUNFLOWER PARK PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-303-4089
Mailing Address - Street 1:1803 E STATE HIGHWAY 243
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-4118
Mailing Address - Country:US
Mailing Address - Phone:972-932-7776
Mailing Address - Fax:972-932-8916
Practice Address - Street 1:1803 E STATE HIGHWAY 243
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-4118
Practice Address - Country:US
Practice Address - Phone:972-932-7776
Practice Address - Fax:972-932-8916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117626314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014223Medicaid
TX001014223Medicaid