Provider Demographics
NPI:1609879493
Name:SUNSHINE TERRACE FOUNDATION, INC
Entity Type:Organization
Organization Name:SUNSHINE TERRACE FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-754-0246
Mailing Address - Street 1:248 W 300 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-3810
Mailing Address - Country:US
Mailing Address - Phone:435-752-0411
Mailing Address - Fax:435-752-1318
Practice Address - Street 1:248 W 300 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-3810
Practice Address - Country:US
Practice Address - Phone:435-752-0411
Practice Address - Fax:435-752-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2004-NCF-86314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========006Medicaid
UT46-5079Medicare ID - Type UnspecifiedMEDICARE NUMBER