Provider Demographics
NPI:1942423330
Name:SUNSHINERS GROUP HOME
Entity type:Organization
Organization Name:SUNSHINERS GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-528-4380
Mailing Address - Street 1:719 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696
Mailing Address - Country:US
Mailing Address - Phone:352-528-4380
Mailing Address - Fax:352-528-0091
Practice Address - Street 1:719 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-1709
Practice Address - Country:US
Practice Address - Phone:352-528-4380
Practice Address - Fax:352-528-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL674272696Medicaid