Basic Information
| Provider Information | |||||||||
| NPI: | 1356685630 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNHEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6019 COUNTY ROAD 20 | ||||||||
| Address2: | |||||||||
| City: | ARCHBOLD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435029770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194102680 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1104 WESLEY AVE | ||||||||
| Address2: | |||||||||
| City: | BRYAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435062579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196365071 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2012 | ||||||||
| LastUpdateDate: | 11/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | TAMARA | ||||||||
| AuthorizedOfficialMiddleName: | DEE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4194102680 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | PT012260 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.