Provider Demographics
NPI:1841511656
Name:SUNNY SIDE IN HOME SERVICES LLC
Entity type:Organization
Organization Name:SUNNY SIDE IN HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-276-5373
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MO
Mailing Address - Zip Code:63863-0013
Mailing Address - Country:US
Mailing Address - Phone:573-276-6599
Mailing Address - Fax:
Practice Address - Street 1:19948 STATE HIGHWAY J
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863-5258
Practice Address - Country:US
Practice Address - Phone:573-276-6599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care