Organization
SHINELIGHT, INC
Active
Parent organization
SHINELIGHT, INC
Other names
Wilkinson Facility
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHINELIGHT, INC
Authorized official
NIKKI G CREECY (CEO)
(910) 323-1335
Entity
Organization
Contact information
Practice address
635 N WILKINSON DR, SAINT PAULS, NC 28384-1247
(910) 323-1335
(910) 223-2180
Mailing address
203 ROWAN ST, FAYETTEVILLE, NC 28301-4921
(910) 323-1335
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418071
—
NC
Enumeration date
03/03/2021
Last updated
01/04/2023
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