Provider Demographics
NPI:1134613540
Name:SUNSHINE SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:SUNSHINE SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDWINNA
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-258-0489
Mailing Address - Street 1:9205 REDTAIL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-2811
Mailing Address - Country:US
Mailing Address - Phone:904-258-0489
Mailing Address - Fax:
Practice Address - Street 1:9205 REDTAIL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-2811
Practice Address - Country:US
Practice Address - Phone:904-258-0489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL709924Medicaid