Basic Information
| Provider Information | |||||||||
| NPI: | 1528463304 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNSHINE COMMUNITY HEALTH CENTER, INC | ||||||||
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| OtherOrganizationName: | SUNSHINE COMMUNITH HEALTH WILLOW DENTAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24091 W LONG LAKE ROAD | ||||||||
| Address2: | |||||||||
| City: | WILLOW | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996889999 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | HC 89 BOX 8190 | ||||||||
| Address2: | |||||||||
| City: | TALKEETNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996769701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077332273 | ||||||||
| FaxNumber: | 9077331735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2014 | ||||||||
| LastUpdateDate: | 10/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | BRICKEL | ||||||||
| AuthorizedOfficialFirstName: | VALERA | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9077339216 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | 77895 | AK | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.