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Organization

SUN LIFE FAMILY HEALTH CENTER, INC

Active
Other names
Sun Life Center for Children
Organization subpart
No

Provider details

NPI number
Authorized official
TRAVIS ROBINETTE (CHIEF EXECUTIVE OFFICER)
(520) 836-3446
Entity
Organization

Contact information

Practice address
1856 E FLORENCE BLVD, CASA GRANDE, AZ 85122-5303
(520) 381-0380
(520) 836-1826
Mailing address
PO BOX 10097, CASA GRANDE, AZ 85130-0020
(520) 836-3446
(520) 836-8807

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
OTC4752
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
03-1881
MEDICARE
AZ
05
AZ13154
AZ
01
BL-09-55271
CITY BUSINESS LICENSE
AZ
01
ZFQ31815
MEDICARE
AZ
Enumeration date
12/21/2009
Last updated
08/03/2017
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