Provider Demographics
NPI:1649034190
Name:SHINE YOUR STAR LLC
Entity type:Organization
Organization Name:SHINE YOUR STAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:978-891-2280
Mailing Address - Street 1:31 ATTITASH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRIMAC
Mailing Address - State:MA
Mailing Address - Zip Code:01860-1605
Mailing Address - Country:US
Mailing Address - Phone:978-891-2280
Mailing Address - Fax:
Practice Address - Street 1:31 ATTITASH AVE
Practice Address - Street 2:
Practice Address - City:MERRIMAC
Practice Address - State:MA
Practice Address - Zip Code:01860-1605
Practice Address - Country:US
Practice Address - Phone:978-891-2280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health