Provider Demographics
NPI:1689736399
Name:SUNSHINE STATION AT SARDIS
Entity Type:Organization
Organization Name:SUNSHINE STATION AT SARDIS
Other - Org Name:EARLY INTERVENTION SERVICES AT SARDIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ITFS
Authorized Official - Phone:704-882-7642
Mailing Address - Street 1:4405 SARDIS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-7998
Mailing Address - Country:US
Mailing Address - Phone:704-320-4686
Mailing Address - Fax:704-973-0844
Practice Address - Street 1:4405 SARDIS CHURCH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-7998
Practice Address - Country:US
Practice Address - Phone:704-320-4686
Practice Address - Fax:704-973-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, BlindGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300008KMedicaid