| Shinelight, Inc | |
|
203 Rowan St Fayetteville NC 28301-4921 | |
| (910) 257-6406 | |
| Not Available |
| Full Name | Shinelight, Inc |
|---|---|
| Speciality | Residential Treatment Facility, Intellectual And/or Developmental Disabilities |
| Location | 203 Rowan St, Fayetteville, North Carolina |
| Authorized Official Name and Position | Nikki Giovanni Creecy (CEO) |
| Authorized Official Contact | 9102576406 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shinelight, Inc 203 Rowan St Fayetteville NC 28301-4921 Ph: (910) 257-6406 | Shinelight, Inc 203 Rowan St Fayetteville NC 28301-4921 Ph: (910) 257-6406 |
| NPI Number | 1417370545 |
|---|---|
| Provider Enumeration Date | 01/24/2014 |
| Last Update Date | 04/21/2021 |
| Certification Date | 04/21/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417370545 | NPI | - | NPPES |
| 3418071 | Medicaid | NC |
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