Provider Demographics
NPI:1124079751
Name:SUNSHINE ADULT DAY CARE
Entity type:Organization
Organization Name:SUNSHINE ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:BATES
Authorized Official - Last Name:PUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-429-0505
Mailing Address - Street 1:506B S DUNCAN BYP
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-7219
Mailing Address - Country:US
Mailing Address - Phone:864-429-0505
Mailing Address - Fax:864-429-8578
Practice Address - Street 1:506B S DUNCAN BYP
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-7219
Practice Address - Country:US
Practice Address - Phone:864-429-0505
Practice Address - Fax:864-429-8578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC-251261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX06429999Medicaid