Provider Demographics
NPI:1255168811
Name:SUNSHINE CENTER LLC
Entity type:Organization
Organization Name:SUNSHINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JIMMIE SIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATC
Authorized Official - Phone:478-463-5812
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:GA
Mailing Address - Zip Code:30445-0411
Mailing Address - Country:US
Mailing Address - Phone:478-463-5812
Mailing Address - Fax:877-912-3006
Practice Address - Street 1:4694 W LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:SOPERTON
Practice Address - State:GA
Practice Address - Zip Code:30457-2224
Practice Address - Country:US
Practice Address - Phone:912-529-5220
Practice Address - Fax:877-912-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care