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General NPI Number Information
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NPI Number | 1497581508
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Entity Type | Organization
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Legal Business Name | SHINE TREATMENT CENTER LLC
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 09/21/2024
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Provider Practice Location Address
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Address Line | 3295 E REBEL LN
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-1705
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Country | US
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Telephone | 208-505-7176
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Fax |
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Provider Business Mailing Address
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Address Line | 3295 E REBEL LN
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-1705
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Country | US
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Telephone | 208-505-7176
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DAVID LAWLOR
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Credential |
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Telephone | 208-505-7176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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