Provider Demographics
NPI:1447948369
Name:SHINE AT HOME HOMECARE LLC
Entity type:Organization
Organization Name:SHINE AT HOME HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:PATIENCE
Authorized Official - Middle Name:F
Authorized Official - Last Name:AYOGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-599-2222
Mailing Address - Street 1:2680 E MAIN ST STE 306
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2831
Mailing Address - Country:US
Mailing Address - Phone:317-599-2222
Mailing Address - Fax:
Practice Address - Street 1:2680 E MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2831
Practice Address - Country:US
Practice Address - Phone:317-599-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care