Provider Demographics
NPI:1740717511
Name:SUNSHINE INC RESIDENTIAL AND SUPPORT SERVICES
Entity type:Organization
Organization Name:SUNSHINE INC RESIDENTIAL AND SUPPORT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CIACELLI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:419-794-8602
Mailing Address - Street 1:7223 MAUMEE WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9755
Mailing Address - Country:US
Mailing Address - Phone:419-865-0251
Mailing Address - Fax:419-724-3353
Practice Address - Street 1:7223 MAUMEE WESTERN RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9755
Practice Address - Country:US
Practice Address - Phone:419-865-0251
Practice Address - Fax:419-724-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT006613225100000X
OHSP5871235Z00000X
OHOT001547225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty