Provider Demographics
NPI:1801330485
Name:SUNSHINE REHAB AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:SUNSHINE REHAB AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMEIL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:561-530-3469
Mailing Address - Street 1:4175 S CONGRESS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4175 S CONGRESS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4725
Practice Address - Country:US
Practice Address - Phone:561-452-8563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9182389261QH0100X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0012166-00Medicaid
FLBJ142Medicare UPIN