Shinelight, Inc

Primary specialty

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

Legal business name

SHINELIGHT, INC

Practice address

203 Rowan St
Fayetteville, NC 28301-4921

Phone

(910) 257-6406

NPI assigned

Jan 24, 2014

Organization subpart

Yes

Parent organization

SHINELIGHT, INC.As reported in NPPES

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

Authorized official

Name

Ms. Nikki Giovanni Creecy

Title

Ceo

Phone

(910) 257-6406

Specialties & licenses 3

Addresses

Other identifiers 1

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
  • Saint Pauls, NC
  • NPI 1013502954
  NPD tax ID
• Summerhill

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

Locations

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

{
    "created_epoch": "1390521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618963200000",
    "number": "1417370545",
    "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": "910-257-6406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 ROWAN ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283014921",
            "telephone_number": "910-257-6406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINELIGHT, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHINELIGHT, INC.",
        "enumeration_date": "2014-01-24",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A",
        "authorized_official_last_name": "CREECY",
        "authorized_official_first_name": "NIKKI",
        "authorized_official_middle_name": "GIOVANNI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-257-6406",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418071",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christa Shih
• Adi Shimoni, OTR/L
• Reina Shimozono, PHARMD
• Kevin Daesu Shin, L.AC., PH.D.
• Lucas Kwangsu Shin, DMD
• Shining Star PLLC
• Ashleigh Danielle Shinkle, OTR/L
• Shipman-Fayetteville
• Stephanie Shippy, PA-C
• Madysen Hotchkin Shirer

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Fayetteville, NC
• Providers in Fayetteville, 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 Apr 21, 2021; 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.