Provider Demographics
NPI:1386901841
Name:SONSHINE COMPANION CARE, LLC
Entity type:Organization
Organization Name:SONSHINE COMPANION CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MIRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-346-0352
Mailing Address - Street 1:1010 N 12TH AVE #233
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501
Mailing Address - Country:US
Mailing Address - Phone:850-346-0352
Mailing Address - Fax:
Practice Address - Street 1:1010 N 12TH AVE STE 233
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3380
Practice Address - Country:US
Practice Address - Phone:850-346-0352
Practice Address - Fax:850-266-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL231.700253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006638800Medicaid