MEDICARE: SHININGSTARRS HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	16059683	GA

General Provider Information

NPI Number	:	1386189231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHININGSTARRS HOME CARE LLC

Provider Business Mailing Address
First Line	:	1880 BRASELTON HWY
Second Line	:	SUITE 118 #5065
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-2852
Country	:	US
Telephone Number	:	678-404-6659
Fax Number	:	678-804-1852

Provider Business Practice Location Address
First Line	:	1880 BRASELTON HWY
Second Line	:	SUITE 118 #5065
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-2852
Country	:	US
Telephone Number	:	678-404-6659
Fax Number	:	678-804-1852

Authorized Official
Title or Position	:	OWNER
Name	:	STARR UNIQUE EADY
Credential	:	CNA
Telephone Number	:	678-860-0792

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	01/03/2017

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