Healthcare Provider Details

I. General information

NPI: 1639226251
Provider Name (Legal Business Name): SHANGRI-LA ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 EGG AND BUTTER RD
COLUMBIANA AL
35051-9479
US

IV. Provider business mailing address

155 EGG AND BUTTER RD
COLUMBIANA AL
35051-9479
US

V. Phone/Fax

Practice location:
  • Phone: 205-669-9202
  • Fax: 205-669-9202
Mailing address:
  • Phone: 205-669-9202
  • Fax: 205-669-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. RIZALINA DURAN NICHOLS
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 205-613-7463