Provider Demographics
NPI:1710589056
Name:SUNSHINEADULT FAMILY HOME LLC
Entity Type:Organization
Organization Name:SUNSHINEADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEMIROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PROVIDER
Authorized Official - Phone:206-356-9203
Mailing Address - Street 1:928 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-2215
Mailing Address - Country:US
Mailing Address - Phone:206-356-9203
Mailing Address - Fax:
Practice Address - Street 1:4905 SEAVIEW WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-1431
Practice Address - Country:US
Practice Address - Phone:206-356-9203
Practice Address - Fax:425-789-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health