Provider Demographics
NPI:1639554488
Name:SUNSHINE VILLA HOMES LLC
Entity Type:Organization
Organization Name:SUNSHINE VILLA HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-380-4113
Mailing Address - Street 1:1515 E MALONE AVE
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-3413
Mailing Address - Country:US
Mailing Address - Phone:573-471-0466
Mailing Address - Fax:573-471-4918
Practice Address - Street 1:2520 JAMES ST
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:MO
Practice Address - Zip Code:63780-1219
Practice Address - Country:US
Practice Address - Phone:573-264-2424
Practice Address - Fax:573-471-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility