Provider Demographics
NPI:1831520394
Name:SUNSHINE HEART HOMECARE LLC
Entity type:Organization
Organization Name:SUNSHINE HEART HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-422-6647
Mailing Address - Street 1:9378 ARLINGTON EXPY
Mailing Address - Street 2:218
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-8213
Mailing Address - Country:US
Mailing Address - Phone:904-422-6647
Mailing Address - Fax:
Practice Address - Street 1:9378 ARLINGTON EXPRESSWAY
Practice Address - Street 2:218
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7416
Practice Address - Country:US
Practice Address - Phone:904-422-6647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233389253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010775800Medicaid