Provider Demographics
NPI:1487175899
Name:SUNSHINE STATE LIVING, INC.
Entity type:Organization
Organization Name:SUNSHINE STATE LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIVANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-249-6845
Mailing Address - Street 1:2894 52ND LN N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-3441
Mailing Address - Country:US
Mailing Address - Phone:727-249-6845
Mailing Address - Fax:
Practice Address - Street 1:2894 52ND LN N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-3441
Practice Address - Country:US
Practice Address - Phone:727-249-6845
Practice Address - Fax:727-249-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities