Provider Demographics
NPI:1942909635
Name:SHINE CHRISTIAN SENIOR CENTER
Entity Type:Organization
Organization Name:SHINE CHRISTIAN SENIOR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:HAEKANG
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-426-1904
Mailing Address - Street 1:1795 BUFORD HWY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2806
Mailing Address - Country:US
Mailing Address - Phone:470-426-1904
Mailing Address - Fax:
Practice Address - Street 1:1795 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2806
Practice Address - Country:US
Practice Address - Phone:470-426-1904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHINE LIGHT INTERNATIONAL BAPTIST CHURCH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care