Provider Demographics
NPI:1023346020
Name:SUNNY'S HOME CARE INC
Entity type:Organization
Organization Name:SUNNY'S HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:WOODBURY, JR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-766-2411
Mailing Address - Street 1:2554 LEWISVILLE CLEMMONS RD
Mailing Address - Street 2:STE 306-G
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8110
Mailing Address - Country:US
Mailing Address - Phone:336-766-2411
Mailing Address - Fax:336-766-2413
Practice Address - Street 1:2554 LEWISVILLE CLEMMONS RD
Practice Address - Street 2:STE 306-G
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8110
Practice Address - Country:US
Practice Address - Phone:336-766-2411
Practice Address - Fax:336-766-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253Z00000X
253Z00000X
NCHC3990253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601931Medicaid
NC3418762Medicaid