Provider Demographics
NPI:1801635735
Name:SUNFLOWER VILLAGE HOME CARE, LLC
Entity type:Organization
Organization Name:SUNFLOWER VILLAGE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:LATRECE
Authorized Official - Last Name:WILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:984-284-0044
Mailing Address - Street 1:120 PRESTON EXECUTIVE DR STE 236
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8445
Mailing Address - Country:US
Mailing Address - Phone:984-284-0044
Mailing Address - Fax:
Practice Address - Street 1:120 PRESTON EXECUTIVE DR STE 236
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8445
Practice Address - Country:US
Practice Address - Phone:984-284-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care