Provider Demographics
NPI:1790802486
Name:SUNSHINE COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SUNSHINE COMMUNITY HEALTH CENTER
Other - Org Name:SUNSHINE COMMUNITY HEALTH CLINIC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALECA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-733-2273
Mailing Address - Street 1:HC 89 BOX 8190
Mailing Address - Street 2:
Mailing Address - City:TALKEETNA
Mailing Address - State:AK
Mailing Address - Zip Code:99676-9701
Mailing Address - Country:US
Mailing Address - Phone:907-733-2273
Mailing Address - Fax:907-733-1735
Practice Address - Street 1:34300 S. TALKEETNA SPUR RD,
Practice Address - Street 2:
Practice Address - City:TALKEETNA
Practice Address - State:AK
Practice Address - Zip Code:99676-9701
Practice Address - Country:US
Practice Address - Phone:907-733-2273
Practice Address - Fax:907-733-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK77895261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDDG83FQMedicaid