| Shining New Light Llc | |
|
4050 E Greenway Rd Ste 4 Phoenix AZ 85032-4700 | |
| (630) 900-7568 | |
| Not Available |
| Full Name | Shining New Light Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4050 E Greenway Rd Ste 4, Phoenix, Arizona |
| Authorized Official Name and Position | Kandace Wadlington (ACTING CHIEF ADMIN. OFFICER) |
| Authorized Official Contact | 7736003507 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shining New Light Llc 4050 E Greenway Rd Ste 4 Phoenix AZ 85032-4700 Ph: () - | Shining New Light Llc 4050 E Greenway Rd Ste 4 Phoenix AZ 85032-4700 Ph: (630) 900-7568 |
| NPI Number | 1558015115 |
|---|---|
| Provider Enumeration Date | 02/11/2022 |
| Last Update Date | 02/11/2022 |
| Certification Date | 02/11/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558015115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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