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General NPI Number Information
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NPI Number | 1184491219
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Entity Type | Organization
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Legal Business Name | SHINE HEALTHCARE GROUP LLC
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Dates
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Enumeration Date | 12/08/2023
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 353 LEXINGTON AVE FL 4
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City | NEW YORK
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State | NY
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Zip | 10016-0941
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Country | US
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Telephone | 866-888-2150
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Fax |
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Provider Business Mailing Address
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Address Line | 3631 CHAMBLEE TUCKER RD STE A288
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City | ATLANTA
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State | GA
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Zip | 30341-4415
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Country | US
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Telephone | 678-469-9526
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JASMIN L BOOKER
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Credential |
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Telephone | 404-491-7716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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