Organization
SHINING NEW LIGHT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KANDACE WADLINGTON (ACTING CHIEF ADMIN. OFFICER)
(773) 600-3507
Entity
Organization
Contact information
Practice address
4050 E GREENWAY RD STE 4, PHOENIX, AZ 85032-4700
(630) 900-7568
Mailing address
4050 E GREENWAY RD STE 4, PHOENIX, AZ 85032-4700
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/11/2022
Last updated
02/11/2022
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