Provider Demographics
NPI:1285179341
Name:SHINE HOME CARE
Entity Type:Organization
Organization Name:SHINE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEKABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-806-3258
Mailing Address - Street 1:10501 PACIFIC PALISADES AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144
Mailing Address - Country:US
Mailing Address - Phone:702-806-3258
Mailing Address - Fax:702-822-0085
Practice Address - Street 1:10501 PACIFIC PALISADES AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144
Practice Address - Country:US
Practice Address - Phone:702-806-3258
Practice Address - Fax:702-822-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health