Healthcare Provider Details

I. General information

NPI: 1265070627
Provider Name (Legal Business Name): SHOP-ILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 N MAIN ST UNIT A
JACOBUS PA
17407-1256
US

IV. Provider business mailing address

24 STONEWOOD DR
JACOBUS PA
17407-1261
US

V. Phone/Fax

Practice location:
  • Phone: 717-676-6670
  • Fax:
Mailing address:
  • Phone: 717-676-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SELDEN GRANAHAN
Title or Position: OWNER/PRESIDENT
Credential: MHA
Phone: 717-676-6670