Sunshine Assisted Living

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

ALH6156 Issued in AZ

Legal business name

SUNSHINE ASSISTED LIVING

Practice address

1815 Airfield Ave
Kingman, AZ 86401-4004

Phone

(928) 753-9428

Fax

(928) 565-7472

NPI assigned

May 31, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Enid Ballentine

Title

Manager

Phone

(928) 753-9428

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218153600000",
    "number": "1992906408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 AIRFIELD AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014004",
            "telephone_number": "928-753-9428",
            "fax_number": "928-565-7472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 AIRFIELD AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014004",
            "telephone_number": "928-753-9428",
            "fax_number": "928-565-7472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNSHINE ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2008-08-08",
        "status": "A",
        "authorized_official_last_name": "BALLENTINE",
        "authorized_official_first_name": "ENID",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "928-753-9428",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "AZ",
            "license": "ALH6156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204833",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniela Suarez, DO
• Mohammad Abdul Subhan, M.D.
• Daniel Joseph Sullivan, M.D.
• Jerry L Sullivan, DDS
• Katie Sumpter, MD
• Ryan E Swapp, MD
• Jenni L Swenson, LPC, ATR-BC
• Sycamore Avenue Medical Center, PLLC
• Olisaeloka Tabugbo
• Xin Yee Tan, MD

• Adult Care Home Facility in Kingman, AZ
• Providers in Kingman, AZ by specialty
• Adult Care Home Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2008; 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.