Provider Demographics
NPI:1215527031
Name:SHINING HEARTS LLC
Entity type:Organization
Organization Name:SHINING HEARTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JANAE
Authorized Official - Middle Name:ELIGINO
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-414-1669
Mailing Address - Street 1:101 N COLORADO ST # 1181
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5534
Mailing Address - Country:US
Mailing Address - Phone:520-414-1669
Mailing Address - Fax:
Practice Address - Street 1:101 N COLORADO ST # 1181
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5534
Practice Address - Country:US
Practice Address - Phone:520-414-1669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHINING HEARTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-25
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health