Provider Demographics
NPI:1588294193
Name:SHINING STAR RESIDENTIAL FACILITY, LLC.
Entity type:Organization
Organization Name:SHINING STAR RESIDENTIAL FACILITY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FELISTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AWHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-767-3139
Mailing Address - Street 1:1277 HIGHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5455
Mailing Address - Country:US
Mailing Address - Phone:469-767-3139
Mailing Address - Fax:972-759-9029
Practice Address - Street 1:1277 HIGHVIEW DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-5455
Practice Address - Country:US
Practice Address - Phone:469-767-3139
Practice Address - Fax:972-759-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility