Shine Adult Care LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SHINE ADULT CARE LLC

Doing business as

Shine Adult Care LLC

Practice address

10926 David Taylor Dr Ste 102
Charlotte, NC 28262-1042

Phone

(980) 217-3340

NPI assigned

Aug 12, 2024

Organization subpart

No

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

Authorized official

Name

Mrs. Jacquetta Reshon ColemanNPI 1093904021

Title

Owner/Ceo

Phone

(704) 906-2017

Specialties & licenses 1

Addresses

Other names 1

• Shine Adult Care LLC Doing business as

Locations

Practitioners 1

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

• Jacquetta Reshon Coleman

  • Community/Behavioral Health Agency
  • Charlotte, NC
  • NPI 1093904021
  NPD Authorized official

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

{
    "created_epoch": "1723420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1801627807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10926 DAVID TAYLOR DR STE 120",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282620039",
            "telephone_number": "980-217-3340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10926 DAVID TAYLOR DR STE 102",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282621042",
            "telephone_number": "980-217-3340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE ADULT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-12",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "JACQUETTA",
        "authorized_official_middle_name": "RESHON",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "704-906-2017",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shine Adult Care LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shine Adult Care LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shiland Family Medicine
• Alexandra Shea Shillingburg, PHARMD, BCOP
• Adriane Kilar Shilmover, DMD
• John Michael Shimko, D.P.M.
• Jihye Shin, NP
• Shine Counseling, PLLC
• Shine Therapy LLC
• Stephanie Shine, CSAC
• Willie Shine, CSAC
• Lakesha Shingler Howell, LCSW, LCAS

• Community/Behavioral Health Agency in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; 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.