Healthcare Provider Details

I. General information

NPI: 1164475067
Provider Name (Legal Business Name): SHRINATHJI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 CENTRAL AVE
ST PETERSBURG FL
33713-8845
US

IV. Provider business mailing address

8319 118TH AVE
LARGO FL
33773-5050
US

V. Phone/Fax

Practice location:
  • Phone: 727-323-9405
  • Fax:
Mailing address:
  • Phone: 727-323-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number7919
License Number StateFL

VIII. Authorized Official

Name: RAGHUVIR AMIN
Title or Position: DIRECTOR
Credential:
Phone: 727-323-9405