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Organization
COLLEGE LAKES
Active
Organization
COLLEGE LAKES
Active
Parent organization
SHINELIGHT, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHINELIGHT, INC.
Authorized official
NIKKI GIOVANNI CREECY (CEO)
(910) 257-6406
Entity
Organization
Contact information
Practice address
5104 FLATROCK DRIVE, FAYETTEVILLE, NC 28311
(910) 488-6323
(910) 223-2180
Mailing address
5104 FLATROCK DRIVE, FAYETTEVILLE, NC 28311
(910) 257-6406
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-047-133
NC
Other
Enumeration date
01/20/2014
Last updated
04/21/2021
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