Provider Demographics
NPI:1922512730
Name:SUNSHINE HOMES 2 LLC
Entity Type:Organization
Organization Name:SUNSHINE HOMES 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-229-2028
Mailing Address - Street 1:28180 DANVERS DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4248
Mailing Address - Country:US
Mailing Address - Phone:248-229-2028
Mailing Address - Fax:248-538-6882
Practice Address - Street 1:27287 STANFORD ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-3176
Practice Address - Country:US
Practice Address - Phone:313-561-3146
Practice Address - Fax:248-538-6882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820347171251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health