Organization
SHINING STAR
Active
Other names
shining star
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID HAQQ (DIRECTOR)
(910) 978-8599
Entity
Organization
Contact information
Practice address
378 APPALOOSA DR, SPRING LAKE, NC 28390-8504
(910) 904-6699
(910) 904-1879
Mailing address
PO BOX 2744, FAYETTEVILLE, NC 28302-2744
(910) 904-6699
(910) 904-1879
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-043-045
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603538
—
NC
Enumeration date
09/20/2006
Last updated
04/22/2008
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