Provider Demographics
NPI:1992511661
Name:SONSHINE COMMUNITY OUTREACH SERVICES
Entity type:Organization
Organization Name:SONSHINE COMMUNITY OUTREACH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LEYTANYER
Authorized Official - Last Name:CORNELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:BA,CPSS,QP
Authorized Official - Phone:704-232-5327
Mailing Address - Street 1:607 GRANTS CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:NC
Mailing Address - Zip Code:28159-1563
Mailing Address - Country:US
Mailing Address - Phone:704-232-5327
Mailing Address - Fax:
Practice Address - Street 1:607 GRANTS CROSSING LN
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NC
Practice Address - Zip Code:28159-1563
Practice Address - Country:US
Practice Address - Phone:704-232-5327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty