Shine on Me Inc. of Illinois

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

201400008C Issued in IL

Legal business name

SHINE ON ME INC. OF ILLINOIS

Practice address

153 Nanti St
Park Forest, IL 60466-2529

Phone

(708) 506-3900

NPI assigned

Dec 22, 2015

Organization subpart

No

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

Authorized official

Name

Roselyn ShineNPI 1962888511

Title

Ceo

Phone

(708) 743-7011

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roselyn Shine

  • Community/Behavioral Health Agency
  • Park Forest, IL
  • NPI 1962888511
  NPD (past) Authorized official

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

{
    "created_epoch": "1450742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450742400000",
    "number": "1538524236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 NANTI ST",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604662529",
            "telephone_number": "708-506-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 NANTI ST",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604662529",
            "telephone_number": "708-506-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE ON ME INC. OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-22",
        "last_updated": "2015-12-22",
        "status": "A",
        "authorized_official_last_name": "SHINE",
        "authorized_official_first_name": "ROSELYN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-743-7011"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "201400008C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20150923983310",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lena Safi
• Serenity Healthcare Consultants, Limited
• Serenity Healthcare Professionals LLC
• David Joseph Sheldon, LICENSED SPEECH-LANG
• Stephanie Michelle Shelton, LCSW
• Roselyn Shine
• Simabllc
• Simplifycare Inc
• Sound Diagnostics LTD
• Barbara Spears, D.T.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Park Forest, IL
• Providers in Park Forest, IL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2015; 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.