Provider Demographics
NPI:1386189231
Name:SHININGSTARRS HOME CARE LLC
Entity Type:Organization
Organization Name:SHININGSTARRS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STARR
Authorized Official - Middle Name:UNIQUE
Authorized Official - Last Name:EADY
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:678-860-0792
Mailing Address - Street 1:1880 BRASELTON HWY
Mailing Address - Street 2:SUITE 118 #5065
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2852
Mailing Address - Country:US
Mailing Address - Phone:678-404-6659
Mailing Address - Fax:678-804-1852
Practice Address - Street 1:1880 BRASELTON HWY
Practice Address - Street 2:SUITE 118 #5065
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-2852
Practice Address - Country:US
Practice Address - Phone:678-404-6659
Practice Address - Fax:678-804-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16059683251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health