1992812796 NPI number — SUNSHINE VILLAGE, INC

Table of content: (NPI 1992812796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992812796 NPI number — SUNSHINE VILLAGE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSHINE VILLAGE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992812796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 LITWIN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICOPEE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01020-4898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-592-6142
Provider Business Mailing Address Fax Number:
413-598-0478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 LITWIN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICOPEE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01020-4898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-592-6142
Provider Business Practice Location Address Fax Number:
413-598-0478
Provider Enumeration Date:
08/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAMATHEVAN
Authorized Official First Name:
SUDHAKAR
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
413-592-6142

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1303228 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1310747 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1317580 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1304411 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1310712 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1311751 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".