Provider Demographics
NPI:1689339723
Name:RAYS OF SUNSHINE ENTERPRISE, LLC
Entity Type:Organization
Organization Name:RAYS OF SUNSHINE ENTERPRISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:RAVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-527-1972
Mailing Address - Street 1:232 COCKEYSVILLE RD STE A102
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2142
Mailing Address - Country:US
Mailing Address - Phone:410-527-1972
Mailing Address - Fax:
Practice Address - Street 1:232 COCKEYSVILLE RD STE A102
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2142
Practice Address - Country:US
Practice Address - Phone:410-527-1972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)