Provider Demographics
NPI:1457866659
Name:SHINING STAR BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:SHINING STAR BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSMANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-439-5798
Mailing Address - Street 1:18000 NW 2ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4306
Mailing Address - Country:US
Mailing Address - Phone:786-439-5798
Mailing Address - Fax:305-974-2834
Practice Address - Street 1:18000 NW 2ND CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4306
Practice Address - Country:US
Practice Address - Phone:786-439-5798
Practice Address - Fax:305-974-2834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health