Basic Information
| Provider Information | |||||||||
| NPI: | 1184698581 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNFLOWER PARK HEALTH CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 E HIGHWAY 243 | ||||||||
| Address2: | |||||||||
| City: | KAUFMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751424118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729327776 | ||||||||
| FaxNumber: | 9729328916 | ||||||||
| Practice Location | |||||||||
| Address1: | 1803 E HIGHWAY 243 | ||||||||
| Address2: | |||||||||
| City: | KAUFMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751424118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729327776 | ||||||||
| FaxNumber: | 9729328916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OSULLIVAN | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9729327776 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 113226 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 004102 | 05 | TX | MEDICAID |