Provider Demographics
NPI:1083387302
Name:SHINING STARS HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:SHINING STARS HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:346-445-3387
Mailing Address - Street 1:20507 REGAL SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5459
Mailing Address - Country:US
Mailing Address - Phone:281-463-7794
Mailing Address - Fax:
Practice Address - Street 1:20507 REGAL SHADOW LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5459
Practice Address - Country:US
Practice Address - Phone:281-463-7794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty