Healthcare Provider Details

I. General information

NPI: 1942870258
Provider Name (Legal Business Name): SHINE GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1271 KELLY JOHNSON BLVD STE 220
COLORADO SPRINGS CO
80920-3962
US

IV. Provider business mailing address

10200 E GIRARD AVE STE B450
DENVER CO
80231-5638
US

V. Phone/Fax

Practice location:
  • Phone: 720-308-1230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NATHAN MILLER
Title or Position: OWNER
Credential:
Phone: 720-308-1230