Organization
SHININGSTAR INDEPENDENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCIA OLUFUNMILAYO AJAYI (CEO)
(240) 374-2292
Entity
Organization
Contact information
Practice address
5146 N 11TH AVE APT D208, PHOENIX, AZ 85013-2161
(240) 374-2292
Mailing address
5146 N 11TH AVE APT D208, PHOENIX, AZ 85013-2161
(240) 374-2292
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/20/2020
Last updated
04/20/2020
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