Provider Demographics
NPI:1255876504
Name:SUNSET HOME
Entity type:Organization
Organization Name:SUNSET HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-223-2636
Mailing Address - Street 1:418 WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4862
Mailing Address - Country:US
Mailing Address - Phone:217-223-2636
Mailing Address - Fax:217-233-6750
Practice Address - Street 1:418 WASHINGTON
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4862
Practice Address - Country:US
Practice Address - Phone:217-223-2636
Practice Address - Fax:217-233-6750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNSET HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)