Provider Demographics
NPI:1518282532
Name:SHINE ON GROUP HOMES, LLC
Entity Type:Organization
Organization Name:SHINE ON GROUP HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOEPPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-237-9692
Mailing Address - Street 1:12107 LAS NUBES ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-5944
Mailing Address - Country:US
Mailing Address - Phone:830-237-9692
Mailing Address - Fax:
Practice Address - Street 1:6162 LITTLE BRANDYWINE CRK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-4618
Practice Address - Country:US
Practice Address - Phone:830-237-9692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities