Provider Demographics
NPI:1205949393
Name:SUNSHINE HOME ASSISTANCE SERVICES, INC
Entity type:Organization
Organization Name:SUNSHINE HOME ASSISTANCE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-483-6878
Mailing Address - Street 1:222 W WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-3606
Mailing Address - Country:US
Mailing Address - Phone:260-483-6878
Mailing Address - Fax:260-471-9234
Practice Address - Street 1:222 W WAYNE ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3606
Practice Address - Country:US
Practice Address - Phone:260-483-6878
Practice Address - Fax:260-471-9234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health