Provider Demographics
NPI:1710505201
Name:SHINE THERAPY, LLC
Entity Type:Organization
Organization Name:SHINE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-390-2594
Mailing Address - Street 1:25065 SANBORN RD
Mailing Address - Street 2:
Mailing Address - City:CALHAN
Mailing Address - State:CO
Mailing Address - Zip Code:80808-8510
Mailing Address - Country:US
Mailing Address - Phone:308-390-2594
Mailing Address - Fax:
Practice Address - Street 1:25065 SANBORN RD
Practice Address - Street 2:
Practice Address - City:CALHAN
Practice Address - State:CO
Practice Address - Zip Code:80808-8510
Practice Address - Country:US
Practice Address - Phone:308-390-2594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty