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General NPI Number Information
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NPI Number | 1801481676
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Entity Type | Organization
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Legal Business Name | SHINING LIGHT LLC
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 3265 N FORT APACHE RD STE 150
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City | LAS VEGAS
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State | NV
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Zip | 89129
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Country | US
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Telephone | 702-906-0044
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Fax | 702-800-4651
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Provider Business Mailing Address
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Address Line | 9811 W CHARLESTON BLVD # 2-441
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City | LAS VEGAS
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State | NV
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Zip | 89117-7528
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Country | US
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Telephone | 702-420-7704
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Fax | 702-800-4651
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MIGUEL VENERACION
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Credential | RN
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Telephone | 702-906-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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