Provider Demographics
NPI:1619995578
Name:SIGNATURE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:SIGNATURE HEALTH SERVICES INC
Other - Org Name:SUNSHINE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-972-6450
Mailing Address - Street 1:1711 HAMMONDVILLE RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-1989
Mailing Address - Country:US
Mailing Address - Phone:954-972-6450
Mailing Address - Fax:954-972-7028
Practice Address - Street 1:1711 HAMMONDVILLE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-1989
Practice Address - Country:US
Practice Address - Phone:954-972-6450
Practice Address - Fax:954-972-7028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4684207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255566200Medicaid
FL255566200Medicaid