Provider Demographics
NPI:1740005792
Name:SUNSHINE COMMUNITY HEALTH CENTER, INC.
Entity type:Organization
Organization Name:SUNSHINE COMMUNITY HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-733-2273
Mailing Address - Street 1:HC 89 BOX 8190
Mailing Address - Street 2:
Mailing Address - City:TALKEETNA
Mailing Address - State:AK
Mailing Address - Zip Code:99676-9701
Mailing Address - Country:US
Mailing Address - Phone:907-733-2273
Mailing Address - Fax:907-733-1753
Practice Address - Street 1:24091 W LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:WILLOW
Practice Address - State:AK
Practice Address - Zip Code:99688-0519
Practice Address - Country:US
Practice Address - Phone:907-733-2273
Practice Address - Fax:907-733-1753
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNSHINE COMMUNITY HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-15
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy