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Organization

SHINE ON ME INC. OF ILLINOIS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROSELYN SHINE (CEO)
(708) 743-7011
Entity
Organization

Contact information

Practice address
153 NANTI ST, PARK FOREST, IL 60466-2529
(708) 506-3900
Mailing address
153 NANTI ST, PARK FOREST, IL 60466-2529
(708) 506-3900

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
201400008C
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
20150923983310
IL
Enumeration date
12/22/2015
Last updated
12/22/2015
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