Provider Demographics
NPI:1699037101
Name:SUNSHINE HAVEN, INC.
Entity Type:Organization
Organization Name:SUNSHINE HAVEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHULL
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:956-350-8400
Mailing Address - Street 1:PO BOX 4478
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-4478
Mailing Address - Country:US
Mailing Address - Phone:956-350-8400
Mailing Address - Fax:956-350-8089
Practice Address - Street 1:7105 W LAKESIDE BLVD
Practice Address - Street 2:
Practice Address - City:OLMITO
Practice Address - State:TX
Practice Address - Zip Code:78575-9767
Practice Address - Country:US
Practice Address - Phone:956-350-8400
Practice Address - Fax:956-350-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25251G00000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient