Provider Demographics
NPI:1225611866
Name:SHINING STARS LLC
Entity Type:Organization
Organization Name:SHINING STARS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FUALUPE
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:MOUNGALOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-696-8897
Mailing Address - Street 1:2862 S DAY LILLY DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-6740
Mailing Address - Country:US
Mailing Address - Phone:801-696-8897
Mailing Address - Fax:
Practice Address - Street 1:2862 S DAY LILLY DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-6740
Practice Address - Country:US
Practice Address - Phone:801-696-8897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency