Provider Demographics
NPI:1730203563
Name:SONSHINE HOME INC
Entity type:Organization
Organization Name:SONSHINE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEOTA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:DICKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-785-0482
Mailing Address - Street 1:2056 AA HWY
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901
Mailing Address - Country:US
Mailing Address - Phone:573-785-0482
Mailing Address - Fax:573-776-7278
Practice Address - Street 1:2056 AA HWY
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901
Practice Address - Country:US
Practice Address - Phone:573-785-0482
Practice Address - Fax:573-776-7278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered385H00000XRespite Care FacilityRespite Care