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Organization
SHINELIGHT, INC
Active
Organization
SHINELIGHT, INC
Active
Parent organization
SHINELIGHT, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHINELIGHT, INC.
Authorized official
MS. NIKKI GIOVANNI CREECY (CEO)
(910) 257-6406
Entity
Organization
Contact information
Practice address
203 ROWAN ST, FAYETTEVILLE, NC 28301-4921
(910) 257-6406
Mailing address
203 ROWAN ST, FAYETTEVILLE, NC 28301-4921
(910) 257-6406
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
01/24/2014
Last updated
04/21/2021
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