Provider Demographics
NPI:1437869534
Name:SHINE AUTISM LLC
Entity Type:Organization
Organization Name:SHINE AUTISM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-464-5506
Mailing Address - Street 1:195 14TH ST NE
Mailing Address - Street 2:TOWER SUITE 8
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:195 14TH ST NE
Practice Address - Street 2:TOWER SUITE 8
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2682
Practice Address - Country:US
Practice Address - Phone:352-464-5506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty