SHINING STAR (NPI# 1134226160) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134226160 |
| Entity Type | Organization |
| Organization Name | SHINING STAR |
| Other Organization Name | SHINING STAR |
| Practice Address |
378 Appaloosa Dr Spring Lake NC 28390-8504 |
| Mailing Address |
Po Box 2744 Fayetteville NC 28302-2744 |
| Practice Telephone | 9109046699 |
| Practice Fax Number | 9109041879 |
| Mailing Telephone | 9109046699 |
| Mailing Fax Number | 9109041879 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2008-04-22 |
| Authorized Official Name | DAVID HAQQ (DIRECTOR) |
| Authorized Official Telephone | 9109788599 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | MHL-043-045 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 6603538 | 05 |
| Other Name | Type Code |
|---|---|
| shining star | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SHINING STAR | 236 Nw Bree Dr, Winston, OR 97496 |
| System for Award Management (SAM) Entities | SHINING STAR ACADEMY LLC | 109 S Park St, Wagner, SD 57380-9405 |
| Oregon Corporations, Companies and Business Names | SHINING STAR ADULT FOSTER CARE | 4574 47th Ave Ne, Salem, OR 97305 |
| Colorado Business Entities | Shining Star Caregivers, LLC | 84 Snowslide Court, Durango, CO 81301 |
| Oregon Corporations, Companies and Business Names | SHINING STAR CARPET CLEANING | 14018 Se 97th Ave, Clackamas, OR 97015 |
| New York State Corporations | SHINING STAR CATTLE CO., INC. | 10175 Versailles-Plank Road, North Collins, New York 14111 |
| Washington State Corporations | SHINING STAR CHRISTMAS TREE FARM, INC. | 2701 Ne 369th St., La Center, WA 98629 |
| Colorado Business Entities | Shining Star Cleaning | 2473 Pine Lane, Rifle, CO 81650 |
| Virginia Business Entities | Shining Star Cleaning LLC | 4103 Addison Rd, Fairfax, Virginia 22030 |
| Ohio Business Entities | SHINING STAR CLEANING SERVICE | 190 Albert St, Newton Falls, OH 44444 |
| Street Address |
378 APPALOOSA DR |
| City | SPRING LAKE |
| State | NC |
| Zip Code | 28390-8504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487296208 | Morgan Lubawski | Behavior Technician | 1018 N Bragg Blvd Suite A, Spring Lake, NC 28390 | 2019-10-14 |
| 1285281451 | Cassandra Lynetta Burney | Nurse Practitioner | 104 Lake Ave, Spring Lake, Nc 28390, Spring Lake, NC 28390 | 2019-08-22 |
| 1861956500 | Victoria Denise Bland | Behavior Technician | 1018 N Bragg Blvd Ste A, Spring Lake, NC 28390 | 2019-01-28 |
| 1184102584 | Gregory Scott Seese | Psychologist | 1212 Micahs Way N, Spring Lake, NC 28390 | 2018-07-30 |
| 1174034052 | Danielle Nicole Lord | Specialist | 401 Lillington Hwy N 210, Spring Lake, NC 28390 | 2017-10-18 |
| 1205372588 | Interventional Pain Center, Pllc | Anesthesiology | 517 B Hwy 210 N, Spring Lake, NC 28390 | 2017-01-11 |
| 1699210690 | Rhea Lorena Jimenez | Nurse Practitioner | 517b Hwy 210 N, Spring Lake, NC 28390 | 2016-12-29 |
| 1841641883 | Parise Exquisite | Prosthetic/Orthotic Supplier | 401 Nc-210, Spring Lake, NC 28390 | 2016-06-30 |
| 1083037444 | Dr. Vincent Vissichelli & Associates, D.m.d., P.a. | Dentist | 2980 Ray Road, Spring Lake, NC 28390 | 2014-01-21 |
| 1376820761 | Jamie Gilles | Pharmacist | 512 Villag Lake Court Apt # 201, Spring Lake, NC 28390 | 2011-11-14 |
| Find all providers in zip 28390 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992980676 | Sierra's Residential Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 292 Sierra Trl, Spring Lake, NC 28390-8978 | 2007-12-31 |
| 1811171341 | Ican & Associates | Residential Treatment Facility, Emotionally Disturbed Children | 3002 Brinkley Dr, Spring Lake, NC 28390-1602 | 2007-12-19 |
| 1710160759 | Sierra's Residential Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 21 Lanexa Rd, Spring Lake, NC 28390-8274 | 2007-12-13 |
| 1225166069 | Light House Group | Residential Treatment Facility, Emotionally Disturbed Children | 206 Wapiti Dr, 108 Ashton Pl, Spring Lake, NC 28390-1530 | 2007-03-02 |
| 1265533053 | Diyah's Home, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 10691 Nc Highway 210 S, Spring Lake, NC 28390-8049 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023617255 | Creative Helping Hands LLC | Residential Treatment Facility, Emotionally Disturbed Children | 478 Green Lake Rd, Rockingham, NC 28379-7850 | 2020-10-19 |
| 1083237986 | Revive Housing LLC | Residential Treatment Facility, Emotionally Disturbed Children | 210 Sunset Dr Apt 615, Salisbury, NC 28147-7147 | 2020-05-26 |
| 1457998627 | Re Health Group | Residential Treatment Facility, Emotionally Disturbed Children | 1102 Groves St, Kings Mountain, NC 28086-2232 | 2019-12-05 |
| 1821631532 | Marquita Latrice Walls | Residential Treatment Facility, Emotionally Disturbed Children | 1565 Longbranch Rd, Grover, NC 28073-9599 | 2019-10-25 |
| 1699233866 | A Brighter Path LLC | Residential Treatment Facility, Emotionally Disturbed Children | 120 Jetter Rd, Grover, NC 28073-9687 | 2019-03-06 |
| 1821562224 | Carter Clinic, Pa | Residential Treatment Facility, Emotionally Disturbed Children | 703 W 3rd Ave Bldg A, Red Springs, NC 28377-1524 | 2019-01-18 |
| 1659842607 | Gervonia Robinson | Residential Treatment Facility, Emotionally Disturbed Children | 1714 Aster Ln, Gastonia, NC 28054-8303 | 2018-12-16 |
| 1679058440 | Miracle Houses Inc | Residential Treatment Facility, Emotionally Disturbed Children | 7827 Kerrybrook Cir, Charlotte, NC 28214-2513 | 2018-09-27 |
| 1174048078 | A Safe Place Community Housing, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2049 Highland St, Charlotte, NC 28208-4909 | 2017-08-11 |
| 1104346881 | Inspiration for Us | Residential Treatment Facility, Emotionally Disturbed Children | 1205 W Mountain St, Kernersville, NC 27284-2173 | 2017-06-22 |
| Find all providers with the same taxonomy | ||||
| City | SPRING LAKE |
| Zip Code | 28390 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.