Shiningstar Independent LLC
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Phoenix, AZ. Organization (NPI-2).
Details
- NPI
- 1336769322
- Entity type
- Organization (NPI-2)
- Legal business name
- Shiningstar Independent LLC
- Organization subpart
- No
- Enumeration date
- Apr 20, 2020
- Certification date
- Apr 20, 2020
- Last updated
- Apr 20, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | – | Yes |
| 251E00000X | Home Health | – | – |
Practice location
5146 N 11th Ave Apt D208Phoenix, AZ 85013-2161
Phone 240-374-2292
Mailing address
5146 N 11th Ave Apt D208Phoenix, AZ 85013-2161
Phone 240-374-2292
Authorized official
Lucia Olufunmilayo Ajayi
Ceo
2403742292
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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