Provider Demographics
NPI:1659412518
Name:SUNSHINE TERRACE FOUNDATION, INC.
Entity Type:Organization
Organization Name:SUNSHINE TERRACE FOUNDATION, INC.
Other - Org Name:SUNSHINE TERRACE ADULT DAY CENTER
Other - Org Type:Doing Business As
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:435-754-0246
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:435-754-0246
Practice Address - Fax:435-752-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-HHA-19960251E00000X
UT13533261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========037Medicaid
UT=========041Medicaid
UT=========054Medicaid
UT=========037Medicaid