Provider Demographics
NPI:1073309241
Name:SUNNYSIDE COMMUNITY CARE
Entity type:Organization
Organization Name:SUNNYSIDE COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:413-777-6955
Mailing Address - Street 1:158 CONCORD RD APT H21
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-4638
Mailing Address - Country:US
Mailing Address - Phone:413-777-6955
Mailing Address - Fax:
Practice Address - Street 1:158 CONCORD RD APT H21
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-4638
Practice Address - Country:US
Practice Address - Phone:413-777-6955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health