Provider Demographics
NPI:1063587707
Name:SUN CITY ENVISION HEALTHCARE SERVICES, INC
Entity type:Organization
Organization Name:SUN CITY ENVISION HEALTHCARE SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:915-778-0028
Mailing Address - Street 1:8929 VISCOUNT BLVD
Mailing Address - Street 2:UPPER LEVEL
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5827
Mailing Address - Country:US
Mailing Address - Phone:915-778-0028
Mailing Address - Fax:915-778-0013
Practice Address - Street 1:8929 VISCOUNT BLVD
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5827
Practice Address - Country:US
Practice Address - Phone:915-778-0028
Practice Address - Fax:915-778-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001018163Medicaid
TX671500Medicare Oscar/Certification