Provider Demographics
NPI:1255200952
Name:SHINE YOUR LIGHT ASSISTED LIVING
Entity type:Organization
Organization Name:SHINE YOUR LIGHT ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LALD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERHAAR
Authorized Official - Suffix:
Authorized Official - Credentials:LALD
Authorized Official - Phone:320-241-1855
Mailing Address - Street 1:27818 COUNTY 29
Mailing Address - Street 2:
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347-4575
Mailing Address - Country:US
Mailing Address - Phone:320-241-1855
Mailing Address - Fax:
Practice Address - Street 1:27818 COUNTY 29
Practice Address - Street 2:
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-4575
Practice Address - Country:US
Practice Address - Phone:320-241-1855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based