Shinelight, Inc

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

SHINELIGHT, INC

Doing business as

Wilkinson Facility

Practice address

635 N Wilkinson Dr
Saint Pauls, NC 28384-1247

Phone

(910) 323-1335

Fax

(910) 223-2180

NPI assigned

Mar 3, 2021

Last updated

Jan 4, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

SHINELIGHT, INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nikki G Creecy

Title

Ceo

Phone

(910) 323-1335

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wilkinson Facility Doing business as

Tax ID family

Shinelight Inc4 organizations share this tax ID, including this one

Part of

Shinelight Inc

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• College Lakes

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Fayetteville, NC
  • NPI 1841612215
  NPD tax ID
• Shinelight, Inc

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Fayetteville, NC
  • NPI 1417370545
  NPD tax ID
• Summerhill

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Fayetteville, NC
  • NPI 1336326859
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1013502954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 ROWAN ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283014921",
            "telephone_number": "910-323-1335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 N WILKINSON DR",
            "city": "SAINT PAULS",
            "state": "NC",
            "postal_code": "283841247",
            "telephone_number": "910-323-1335",
            "fax_number": "910-223-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINELIGHT, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHINELIGHT, INC",
        "enumeration_date": "2021-03-03",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A",
        "authorized_official_last_name": "CREECY",
        "authorized_official_first_name": "NIKKI",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-323-1335"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418071",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilkinson Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Righteous Home Care Services, Inc
• Robeson Health Care Corporation (St Pauls Health Center)
• Karis Rozier
• Dyanna Lynn Russell, B.S, CADC
• Ryan, James, Wiles, Patel & Olsen LLP (Village Family Dental)
• Vivian Devone Smith, MSW LCASA
• Southeastern Regional Medical Center (St Pauls Medical Clinic)
• Southeastern Regional Physician Services (St. Pauls Medical Clinic)
• Southeastern Regional Physician Services (The Clinic at Brisson Drug)
• Southeastern Regional Physician Services (St. Pauls Medical Clinic)

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Saint Pauls, NC
• Providers in Saint Pauls, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.