Provider Demographics
NPI:1265484398
Name:SUNNYSIDE RESPIRATORY CARE, INC.
Entity type:Organization
Organization Name:SUNNYSIDE RESPIRATORY CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-488-4450
Mailing Address - Street 1:9045 LA FONTANA BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5636
Mailing Address - Country:US
Mailing Address - Phone:561-488-4450
Mailing Address - Fax:561-488-4451
Practice Address - Street 1:9045 LA FONTANA BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-5636
Practice Address - Country:US
Practice Address - Phone:561-488-4450
Practice Address - Fax:561-488-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5365830001Medicare NSC