Provider Demographics
NPI:1871834846
Name:MARQUITA SHINES
Entity Type:Organization
Organization Name:MARQUITA SHINES
Other - Org Name:ALL SEASON PERSONAL CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARQUITA
Authorized Official - Middle Name:SHUNTA
Authorized Official - Last Name:SHINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-653-0408
Mailing Address - Street 1:55 HICKORY CIR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-8692
Mailing Address - Country:US
Mailing Address - Phone:678-601-3504
Mailing Address - Fax:
Practice Address - Street 1:55 HICKORY CIR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116-8692
Practice Address - Country:US
Practice Address - Phone:678-601-3504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No347C00000XTransportation ServicesPrivate Vehicle