Sunshine Social Service, Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

003155601 Issued in FL

Legal business name

SUNSHINE SOCIAL SERVICE, INC

Practice address

2312 Wilton Dr
200
Wilton Manors, FL 33305-1249

Phone

(954) 764-5150

Fax

(954) 764-5143

NPI assigned

Nov 18, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mark Ketcham, BS

Title

Executive Director

Phone

(954) 764-5150

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SunServe, Inc Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1356771968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2312 WILTON DR",
            "address_2": "200",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333051249",
            "telephone_number": "954-764-5150",
            "fax_number": "954-764-5143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2312 WILTON DR",
            "address_2": "200",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333051249",
            "telephone_number": "954-764-5150",
            "fax_number": "954-764-5143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNSHINE SOCIAL SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-18",
        "last_updated": "2013-11-18",
        "status": "A",
        "authorized_official_last_name": "KETCHAM",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "954-764-5150",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "003155601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003155601",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SunServe, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tannisha Stewart, LMHC
• Daniel Studdard
• Aubriona Stull, LCSW
• Ana Julissa Suarez
• Sunrise ABA Behavior Therapy Corp
• Siwarak Suwandee
• John Davenport Swan Jr., LMHC
• T Falcone Psychology LLC
• Mark Tadros, DMD
• Thomas James Tanner

• Community/Behavioral Health Agency in Wilton Manors, FL
• Providers in Wilton Manors, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.