Provider Demographics
NPI:1174954127
Name:SHINNING STAR SERVICES
Entity type:Organization
Organization Name:SHINNING STAR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-998-8441
Mailing Address - Street 1:3311 53RD AVE N
Mailing Address - Street 2:AOT 202
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3458
Mailing Address - Country:US
Mailing Address - Phone:612-998-8441
Mailing Address - Fax:
Practice Address - Street 1:3311 53RD AVE N
Practice Address - Street 2:AOT 202
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3458
Practice Address - Country:US
Practice Address - Phone:612-998-8441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility