Provider Demographics
NPI:1114763133
Name:SUNSHINE COMMUNITY CARE CENTER LLC
Entity type:Organization
Organization Name:SUNSHINE COMMUNITY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PA
Authorized Official - Middle Name:
Authorized Official - Last Name:VUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:559-478-3736
Mailing Address - Street 1:2705 N CARRIAGE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-0957
Mailing Address - Country:US
Mailing Address - Phone:559-478-3736
Mailing Address - Fax:559-520-4819
Practice Address - Street 1:5108 E CLINTON WAY STE 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-2043
Practice Address - Country:US
Practice Address - Phone:559-375-1058
Practice Address - Fax:559-520-4819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)