Basic Information
| Provider Information | |||||||||
| NPI: | 1922071117 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNSHINE COMMUNITY HEALTH CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 89 BOX 8190 | ||||||||
| Address2: | |||||||||
| City: | TALKEETNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996769701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077332273 | ||||||||
| FaxNumber: | 9077331735 | ||||||||
| Practice Location | |||||||||
| Address1: | 35300 S TALKEETNA SPUR RD | ||||||||
| Address2: | |||||||||
| City: | TALKEETNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077332273 | ||||||||
| FaxNumber: | 9077331735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 07/25/2014 | ||||||||
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| AuthorizedOfficialLastName: | PALERMO | ||||||||
| AuthorizedOfficialFirstName: | MELODY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9077332273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | N | Suppliers | Non-Pharmacy Dispensing Site | 261QF0400X | 77895 | AK | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 1029935 | 05 | AK | MEDICAID |