MEDICARE: SHINING LIGHT HEALTHCARE AGENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1144037276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINING LIGHT HEALTHCARE AGENCY

Provider Business Mailing Address
First Line	:	3259 VAN AKEN BLVD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44120-3507
Country	:	US
Telephone Number	:	216-704-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	3259 VAN AKEN BLVD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44120-3507
Country	:	US
Telephone Number	:	216-704-4747
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN MICHAEL GRIFFIN I
Credential	:	PROVIDERS CARE
Telephone Number	:	216-704-4747

Provider Enumeration Date	:	12/12/2024
Last Update Date	:	12/12/2024

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