Provider Demographics
NPI:1801481676
Name:SHINING LIGHT LLC
Entity type:Organization
Organization Name:SHINING LIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VENERACION
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-906-0044
Mailing Address - Street 1:9811 W CHARLESTON BLVD # 2-441
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7528
Mailing Address - Country:US
Mailing Address - Phone:702-420-7704
Mailing Address - Fax:702-800-4651
Practice Address - Street 1:3265 N FORT APACHE RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129
Practice Address - Country:US
Practice Address - Phone:702-906-0044
Practice Address - Fax:702-800-4651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based