Healthcare Provider Details

I. General information

NPI: 1043317571
Provider Name (Legal Business Name): SHINE N STARS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 CHEROKEE TRL
ANNISTON AL
36206-1021
US

IV. Provider business mailing address

525 CHEROKEE TRL
ANNISTON AL
36206-1021
US

V. Phone/Fax

Practice location:
  • Phone: 256-820-0560
  • Fax: 256-820-0560
Mailing address:
  • Phone: 256-820-0560
  • Fax: 256-820-0560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number034786
License Number StateAL

VIII. Authorized Official

Name: MRS. BARBARA BRIMER
Title or Position: PROPRIETOR
Credential:
Phone: 256-447-2301