Provider Demographics
NPI:1336367101
Name:SUNSHINE VILLAGE, INC,
Entity Type:Organization
Organization Name:SUNSHINE VILLAGE, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUDHAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VAMATHEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-592-6142
Mailing Address - Street 1:75 LITWIN LN
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4817
Mailing Address - Country:US
Mailing Address - Phone:413-592-6142
Mailing Address - Fax:413-598-0478
Practice Address - Street 1:65 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MA
Practice Address - Zip Code:01080-1227
Practice Address - Country:US
Practice Address - Phone:413-289-2023
Practice Address - Fax:413-283-3589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1317580Medicaid