Healthcare Provider Details

I. General information

NPI: 1427949114
Provider Name (Legal Business Name): SHINING LIVES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 6TH ST SW APT 2
CEDAR RAPIDS IA
52404-4089
US

IV. Provider business mailing address

3131 6TH ST SW APT 2
CEDAR RAPIDS IA
52404-4089
US

V. Phone/Fax

Practice location:
  • Phone: 607-232-0419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: YANNICK NDAYISENGA
Title or Position: CEO
Credential:
Phone: 607-232-0419