SHINING STAR LL (NPI# 1356648034) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356648034 |
| Entity Type | Organization |
| Organization Name | SHINING STAR LL |
| Practice Address |
533 Mcdougall St Detroit MI 48207-3912 |
| Mailing Address |
3430 E Jefferson Ave Suite # 401 Detroit MI 48207-4233 |
| Practice Telephone | 3135670121 |
| Mailing Telephone | 3133771849 |
| Mailing Fax Number | 3135572751 |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2011-02-16 |
| Authorized Official Name | MS. STEPHANIE WATT (CEO) |
| Authorized Official Telephone | 3133771849 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Shining Star LLC | 1707 Howard Manor Dr, Vienna, Virginia 22182 |
| Colorado Business Entities | SHINING STAR LLC | 3908 S Pitkin Way, Aurora, CO 80013 |
| Street Address |
533 MCDOUGALL ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48207-3912 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245848506 | Anton R Gonzales | Physical Therapy Assistant | 2295 Chene, Detroit, Mi 48207, Detroit, MI 48207 | 2020-07-22 |
| 1033733928 | Taleshia Moss | Occupational Therapist | 2295 Chene, Detroit, MI 48207 | 2020-06-05 |
| 1942858550 | Ronald Royce Cochran | Counselor | 2925 Russell St, Detroit, Detroit, MI 48207 | 2019-08-27 |
| 1649831439 | Charday Penick | Social Worker | Team Wellness, 2925 Russell St, Detroit, MI 48207 | 2019-06-24 |
| 1568023349 | Alphia Ramona Burgess | Social Worker | Team Wellness Center, 2925 Russell Street, Detroit, MI 48207 | 2019-06-24 |
| 1447741608 | Sherice Ward | Social Worker | 100 River Place Drive, Ste 250, Detroit, MI 48207 | 2018-05-23 |
| 1427549955 | Mission Point of Detroit, LLC | Skilled Nursing Facility | 2102 Orleans, Detroit, MI 48207 | 2018-05-21 |
| 1043723737 | Olivia Carter | Case Management | 2712 Gratiot, Detroit, MI 48207 | 2017-11-16 |
| 1558885590 | Kalimah Johnson | Social Worker | 701 Mcdougall, Detroit, MI 48207 | 2017-08-01 |
| 1922534692 | Angela Young | Social Worker | 100 River Place 520, Detroit, MI 48207 | 2017-05-02 |
| Find all providers in zip 48207 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750859229 | The Noble Home II, Inc | Community Based Residential Treatment Facility, Mental Illness | 327 E Grand Blvd, Detroit, MI 48207-3616 | 2018-11-02 |
| 1679048870 | Neighborhood Living Services,inc. | Community Based Residential Treatment Facility, Mental Illness | 23001 Norfolk St, Detroit, MI 48219-1185 | 2018-10-04 |
| 1851875371 | People Community of Michigan Afc Homes, Inc. | Community Based Residential Treatment Facility, Mental Illness | 16829 Monica St, Detroit, MI 48221-2969 | 2018-09-20 |
| 1083169502 | Emmanuel House | Community Based Residential Treatment Facility, Mental Illness | 14750 Saint Marys St, Detroit, MI 48227-1862 | 2016-08-25 |
| 1407234586 | Karen Frederick LLC | Community Based Residential Treatment Facility, Mental Illness | 5781 Beaconsfield St, Detroit, MI 48224-3157 | 2015-05-11 |
| 1861882821 | Inclusive Solutions LLC | Community Based Residential Treatment Facility, Mental Illness | 4535 Chrysler Dr, Detroit, MI 48201-1954 | 2015-01-29 |
| 1306257852 | Victory Unto Salvation Faith Ministries Dba The Philip House Mission | Community Based Residential Treatment Facility, Mental Illness | 18066 James Couzens Fwy, 2305 Pasadena, Detroit, MI 48235-2646 | 2014-05-17 |
| 1437586039 | Read All About It Literacy Center | Community Based Residential Treatment Facility, Mental Illness | 2727 Second Ave Suite 124, Detroit, MI 48201-4025 | 2013-09-27 |
| 1184922627 | Shar Inc. | Community Based Residential Treatment Facility, Mental Illness | 1852 W.grand Blvd, Detroit, MI 48208 | 2011-03-08 |
| 1659678480 | Shining Star LLC | Community Based Residential Treatment Facility, Mental Illness | 1325 Cadillac Blvd, Detroit, MI 48214-3105 | 2011-02-14 |
| Find all providers in DETROIT | ||||
Please comment or provide details below to improve the information on SHINING STAR LL.
| 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.