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General NPI Number Information
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NPI Number | 1487138939
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Entity Type | Organization
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Legal Business Name | SHINING LIGHT PEER SERVICES
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 3030 POWERS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8043
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Country | US
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Telephone | 904-290-9274
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Fax |
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Provider Business Mailing Address
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Address Line | 14269 PALMETTO SPRINGS ST
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City | JACKSONVILLE
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State | FL
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Zip | 32258-1138
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Country | US
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Telephone | 904-290-9274
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DIANE LINKENAUGER
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Credential | NCRPS
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Telephone | 904-290-9274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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