NPIMap

Organization Active NPI

Shine Healthcare Group LLC

  • Mental Health Counselor
  • Fort Washington, PA
National Provider Identifier
1790471506
Registry record updated Apr 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
SHINE HEALTHCARE GROUP LLC
Practice address
500 W Office Center Dr
Ste400
Fort Washington, PA 19034
Phone
(470) 870-2404
NPI assigned
Apr 14, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2023

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

Authorized official

Name
Jasmin L Booker
Title
Chief Operating Officer
Phone
(470) 870-2404

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

500 W Office Center Dr
Ste400
Fort Washington, PA 19034

Mailing address

3631 Chamblee Tucker Rd Ste A288
Atlanta, GA 30341-4415

National Provider Directory

National Provider Directory
Tax ID family
Shine Healthcare Group7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1681430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681430400000",
    "number": "1790471506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3631 CHAMBLEE TUCKER RD STE A288",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303414415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W OFFICE CENTER DR",
            "address_2": "STE400",
            "city": "FORT WASHINGTON",
            "state": "PA",
            "postal_code": "19034",
            "telephone_number": "470-870-2404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE HEALTHCARE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-14",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-07",
        "status": "A",
        "authorized_official_last_name": "BOOKER",
        "authorized_official_first_name": "JASMIN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "470-870-2404"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Washington, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.