SHINING STAR ASSIST LIVING (NPI# 1306130851) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306130851 |
| Entity Type | Organization |
| Organization Name | SHINING STAR ASSIST LIVING |
| Other Organization Name | SHINING STAR ASSIST LIVING |
| Practice Address |
2941 Westgate Pl Fairbanks AK 99709-4747 |
| Practice Telephone | 9076875944 |
| Mailing Telephone | 9076875944 |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2011-06-01 |
| Authorized Official Name | MR. PAUL MICHEAL WORMAN (OWNER) |
| Authorized Official Telephone | 9076875944 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
AK | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Shining Star assist living | Doing Business As Name - Organization |
| Street Address |
2941 WESTGATE PL |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99709-4747 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255946810 | Beacon Monitoring Professional Services | Technician, Other | 745 Staffordshire Rd, Fairbanks, AK 99709 | 2020-09-10 |
| 1235629544 | Fairbanks Healing Space | Health Educator | 3875 Geist Road, Suite E #136, Fairbanks, AK 99709 | 2018-05-11 |
| 1609395409 | Shawn K Goggins | Counselor | 1423 Peger Road, Fairbanks, AK 99709 | 2017-09-12 |
| 1710433347 | Jay Titus | Technician/Technologist | 2884 Marina Drive, Fairbanks, AK 99709 | 2016-09-01 |
| 1710391610 | Hannah Summerfelt | Dentist | 3539 Thomas St, Fairbanks, AK 99709 | 2014-06-18 |
| 1629407325 | Diane Louise Mitchell | Nurse Practitioner | 4650 Harvard Cir, Fairbanks, AK 99709 | 2013-11-04 |
| 1407147929 | Christina Martz | Counselor | 1270 Summet Drive, Fairbanks, AK 99709 | 2011-05-02 |
| 1255652285 | Surgery Center of Fairbanks LLC | Clinic/Center | 2310 Peger Road, Fairbanks, AK 99709 | 2010-06-14 |
| 1962661835 | John Leo Hughes Jr Jr. | Dentist | 3437 Airport Way, Suite 205, Fairbanks, AL 99709 | 2008-06-05 |
| 1508042417 | Katherine E Johnson, Md PC | Ophthalmology | 2485 Chief William Drive, Suite 100, Fairbanks, AK 99709 | 2008-01-10 |
| Find all providers in zip 99709 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245774108 | Lifetothefullestllc | Assisted Living Facility | 1233 5th Ave, Fairbanks, AK 99701-4211 | 2016-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376169300 | Second Chance Support Services LLC | Assisted Living Facility | 741 Irwin St, Anchorage, AK 99508-1252 | 2020-06-25 |
| 1841815321 | Crisalyn Buenarte Ruiz | Assisted Living Facility | 3541 Corona Cir, Anchorage, AK 99517-1486 | 2020-06-10 |
| 1942858782 | My Home LLC | Assisted Living Facility | 6865 Viburnum Dr, Anchorage, AK 99507-2467 | 2019-08-26 |
| 1699320127 | Wasilla Group Home LLC | Assisted Living Facility | 3660 W Lynn Dr, Wasilla, AK 99654-0949 | 2019-08-01 |
| 1750935433 | Mind and Soul Assisted Living, LLC | Assisted Living Facility | 6124 E 12th Ave # D2, Anchorage, AK 99504-2355 | 2019-07-30 |
| 1689131989 | Tara Walker | Assisted Living Facility | 7774 Cherrywood Cir, Anchorage, AK 99507-2973 | 2019-02-23 |
| 1861966269 | Tina Renee Hopkins | Assisted Living Facility | 3471 W Wren St, Wasilla, AK 99623 | 2019-01-18 |
| 1902381940 | Alkamba Marenah Enterprises, LLC | Assisted Living Facility | 1545 Demeure Pl, Anchorage, AK 99508-3164 | 2018-09-25 |
| 1629585229 | Jessica Tiara Fulton | Assisted Living Facility | 1001 Cherry St Unit A, Anchorage, AK 99504-2230 | 2018-01-04 |
| 1881109767 | Michael Anthony Brown | Assisted Living Facility | 7940 Little Dipper Ave, Anchorage, AK 99504-4125 | 2017-12-13 |
| Find all providers with the same taxonomy | ||||
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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.