Provider Demographics
NPI:1104996636
Name:SUNSHINE MANOR
Entity type:Organization
Organization Name:SUNSHINE MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-684-1550
Mailing Address - Street 1:451 RIO VISTA CT
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-8497
Mailing Address - Country:US
Mailing Address - Phone:352-684-1550
Mailing Address - Fax:352-684-7202
Practice Address - Street 1:451 RIO VISTA CT
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-8497
Practice Address - Country:US
Practice Address - Phone:352-684-1550
Practice Address - Fax:352-684-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL678706196251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services