SHINING STAR LLC (NPI# 1659678480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659678480 |
| Entity Type | Organization |
| Organization Name | SHINING STAR LLC |
| Practice Address |
1325 Cadillac Blvd Detroit MI 48214-3105 |
| Mailing Address |
Po Box 15122 Detroit MI 48215-0122 |
| Practice Telephone | 3133771849 |
| Practice Fax Number | 3135572751 |
| Mailing Telephone | 3133771849 |
| Mailing Fax Number | 3135572751 |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2016-06-03 |
| 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 |
| Connecticut Business Registrations | SHINING STAR LLC | 3395 Main Street, Hartford, CT 06120 |
| Street Address |
1325 CADILLAC BLVD |
| City | DETROIT |
| State | MI |
| Zip Code | 48214-3105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376042325 | Tamara Wesley | Registered Nurse | 9000 E. Jefferson Apt 28-14, Detroit, MI 48214 | 2018-02-06 |
| 1720534381 | Birth Beautiful Detroit | Clinic/Center | 1086 Baldwin, Detroit, MI 48214 | 2016-09-01 |
| 1225402886 | Steven Doyle Whatley I | Counselor | 1423 Field Ave., Adult Well Being Services, Detroit, MI 48214 | 2015-11-19 |
| 1255587945 | Andrew Avery | Internal Medicine | 7733 East Jefferson Ave, Detroit, MI 48214 | 2008-08-13 |
| 1639330210 | Nicole Lashawn Greene | Specialist | 4533 St Clair St, Detroit, MI 48214 | 2008-06-17 |
| 1629299433 | Alan R Faber Jr. | Dentist | 8191 E Jefferson Ave, Detroit, MI 48214 | 2007-05-01 |
| 1518188598 | Mary F Bridges | Psychiatry & Neurology | 8120 East Jefferson #3l, Detroit, MI 48214 | 2007-05-01 |
| 1053439737 | Geraldine Etella Davis | Counselor | 3840 Fairview St., Detroit, MI 48214 | 2007-03-27 |
| 1639203482 | Detroit-macomb Hospital Corporation | Advanced Practice Midwife | 7815 E. Jefferson, Detroit, MI 48214 | 2007-03-15 |
| 1033275441 | Anesha Amor Rouse | Physical Therapy Assistant | 7633 E. Jefferson Ave, Suite 170, Detroit, MI 48214 | 2006-12-29 |
| Find all providers in zip 48214 | ||||
| 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 |
| 1356648034 | Shining Star Ll | Community Based Residential Treatment Facility, Mental Illness | 533 Mcdougall St, Detroit, MI 48207-3912 | 2011-02-16 |
| Find all providers in DETROIT | ||||
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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.