Provider Demographics
NPI:1013452077
Name:SHINE THE LIGHT HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:SHINE THE LIGHT HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF NURSING PRACTICE/FNP
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP/FNP
Authorized Official - Phone:314-448-8867
Mailing Address - Street 1:100 S 4TH ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63102-1800
Mailing Address - Country:US
Mailing Address - Phone:314-797-5121
Mailing Address - Fax:314-797-5001
Practice Address - Street 1:100 S 4TH ST
Practice Address - Street 2:SUITE 550
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63102-1800
Practice Address - Country:US
Practice Address - Phone:314-797-5121
Practice Address - Fax:314-797-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN100257253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care