Provider Demographics
NPI:1619842135
Name:SUNNYSIDE AFH CARE LLC
Entity type:Organization
Organization Name:SUNNYSIDE AFH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MAINA
Authorized Official - Last Name:KIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-510-7236
Mailing Address - Street 1:4393 INDIGO ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-2137
Mailing Address - Country:US
Mailing Address - Phone:503-510-7236
Mailing Address - Fax:503-966-3990
Practice Address - Street 1:4393 INDIGO ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-2137
Practice Address - Country:US
Practice Address - Phone:503-510-7236
Practice Address - Fax:503-966-3990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNNYSIDE AFH CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-06
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty