NPIMap

Organization Active NPI

Shining Light LLC

  • Community Based Hospice Care Agency
  • Las Vegas, NV
National Provider Identifier
1801481676
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SHINING LIGHT LLC
Practice address
3265 N Fort Apache Rd Ste 150
Las Vegas, NV 89129
Phone
(702) 906-0044
Fax
(702) 800-4651
NPI assigned
Mar 4, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Authorized official

Name
Mr. Miguel Veneracion, RN
Title
Administrator
Phone
(702) 906-0044

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

3265 N Fort Apache Rd Ste 150
Las Vegas, NV 89129

Mailing address

9811 W Charleston Blvd # 2-441
Las Vegas, NV 89117-7528
Phone (702) 420-7704

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210503000008 NV Part A Provider - Hospice 9032528161 Practice locations: Las Vegas, NV

Hospice certification: CCN 291600

Legal name
SHINING LIGHT LLC
Doing business as
SHINING LIGHT HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 10, 2022
Last certification
Feb 10, 2022
Ownership / control type
Other
Organization structure
LLCProprietary
Incorporated
Jul 14, 2020 in NV
Enrollment address
3265 N Fort Apache Rd
Ste 150
Las Vegas, NV 89129-0206

Care Compare: Hospice

Medicare Care Compare
Listed as
Shining Light HospiceCCN 291600
Ownership
Other
Certified
Feb 10, 2022
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

3265 N Fort Apache Rd
Ste 150
Las Vegas, NV 89129
Phone (702) 906-0044

9811 W Charleston Blvd
#2441
Las Vegas, NV 89117
Phone (702) 420-7704

3305 Spring Mountain Rd
Ste 29
Las Vegas, NV 89102
Phone (702) 906-0044

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Miguel Veneracion Individual 5% Or Greater Direct Ownership Interest Jul 14, 2020 50%
5% Or Greater Security Interest Jul 14, 2020 50%
Corporate OfficerBoard Member Jul 14, 2020
W-2 Managing EmployeeAd; Jan 1, 2021
Shahab Mokhtare Individual 5% Or Greater Direct Ownership InterestMedical Director Jul 14, 2020 50%
5% Or Greater Security Interest Jul 14, 2020 50%
Corporate OfficerBoard Member Jul 14, 2020
W-2 Managing EmployeeMD; Jan 1, 2021

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Shahab Mokhtare, M.D.
    • Family Medicine Physician
    • Las Vegas, NV
    • NPI 1093913378

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Corporate Officer, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 2

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

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1801481676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9811 W CHARLESTON BLVD # 2-441",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891177528",
            "telephone_number": "702-420-7704",
            "fax_number": "702-800-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3265 N FORT APACHE RD STE 150",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89129",
            "telephone_number": "702-906-0044",
            "fax_number": "702-800-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINING LIGHT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "VENERACION",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "702-906-0044",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.