Healthcare Provider Details

I. General information

NPI: 1912785601
Provider Name (Legal Business Name): SHAN GROUP 3 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 ENTERPRISE AVE STE 251
NAPLES FL
34104-3670
US

IV. Provider business mailing address

15251 NE 18TH AVE STE 9
NORTH MIAMI BEACH FL
33162-6039
US

V. Phone/Fax

Practice location:
  • Phone: 239-837-8064
  • Fax:
Mailing address:
  • Phone: 239-837-8064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALI MANDSAURWALA
Title or Position: OWNER
Credential:
Phone: 305-627-3103