Provider Demographics
NPI:1447863923
Name:SUNSHINE COMMUNITY HEALTH AND WELLNESS OUTREACH CENTER
Entity type:Organization
Organization Name:SUNSHINE COMMUNITY HEALTH AND WELLNESS OUTREACH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:EATMON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:202-878-6128
Mailing Address - Street 1:1100 48TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3914
Mailing Address - Country:US
Mailing Address - Phone:202-905-7581
Mailing Address - Fax:
Practice Address - Street 1:1817 W VIRGINIA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1827
Practice Address - Country:US
Practice Address - Phone:202-878-6128
Practice Address - Fax:202-878-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service