Provider Demographics
NPI:1104618404
Name:SHINING LIGHT CARE LLC
Entity type:Organization
Organization Name:SHINING LIGHT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:NAIN
Authorized Official - Last Name:FONDIKUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-701-2669
Mailing Address - Street 1:20270 MALLARD WAY
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-8716
Mailing Address - Country:US
Mailing Address - Phone:612-701-2669
Mailing Address - Fax:
Practice Address - Street 1:20270 MALLARD WAY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-8716
Practice Address - Country:US
Practice Address - Phone:612-701-2669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management