Provider Demographics
NPI:1538171947
Name:SUNNYBROOK HOME CARE, INC.
Entity type:Organization
Organization Name:SUNNYBROOK HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-472-4808
Mailing Address - Street 1:116 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2811
Mailing Address - Country:US
Mailing Address - Phone:641-472-4808
Mailing Address - Fax:641-472-3339
Practice Address - Street 1:400 HIGHLAND ST STE 102
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3713
Practice Address - Country:US
Practice Address - Phone:641-472-4808
Practice Address - Fax:641-472-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0672907Medicaid
IAWELLMARK BC&BSOtherHHA PROVIDER
IA0672907Medicaid