Healthcare Provider Details

I. General information

NPI: 1972487643
Provider Name (Legal Business Name): SHINE HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32200 MILITARY RD S APT M304
FEDERAL WAY WA
98001-9658
US

IV. Provider business mailing address

32200 MILITARY RD S APT M304
FEDERAL WAY WA
98001-9658
US

V. Phone/Fax

Practice location:
  • Phone: 253-410-9826
  • Fax:
Mailing address:
  • Phone: 253-410-9826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BETTY NANKYA
Title or Position: CEO
Credential: NB
Phone: 253-410-9826