Basic Information
| Provider Information | |||||||||
| NPI: | 1609132026 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUNSHINE MANOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15015 OXNARD ST | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914112613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187874151 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10540 SHERMAN GROVE AVE | ||||||||
| Address2: | |||||||||
| City: | SUNLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910401913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183525941 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2012 | ||||||||
| LastUpdateDate: | 06/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | MACIAS | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8187874151 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VAN NUYS TREATMENT CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.