Provider Demographics
NPI:1700186061
Name:SUNSHINE THERAPY CLUB II INC
Entity Type:Organization
Organization Name:SUNSHINE THERAPY CLUB II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TARAYA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHIRDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:610-853-9919
Mailing Address - Street 1:3300 TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1925
Mailing Address - Country:US
Mailing Address - Phone:610-853-9919
Mailing Address - Fax:610-853-9921
Practice Address - Street 1:3300 TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1925
Practice Address - Country:US
Practice Address - Phone:610-853-9919
Practice Address - Fax:610-853-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008092540003Medicaid