Provider Demographics
NPI:1962687319
Name:SUNSHINE THERAPY CLUB INC
Entity type:Organization
Organization Name:SUNSHINE THERAPY CLUB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARAYA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHIRDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-853-9919
Mailing Address - Street 1:410 W TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5237
Mailing Address - Country:US
Mailing Address - Phone:610-853-9919
Mailing Address - Fax:610-853-9921
Practice Address - Street 1:410 W TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5237
Practice Address - Country:US
Practice Address - Phone:610-853-9919
Practice Address - Fax:610-853-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000061970006Medicaid