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General NPI Number Information
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NPI Number | 1356156186
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Entity Type | Organization
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Legal Business Name | SHAN GROUP 4 LLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 621 NW 53RD ST 125 OFFICE18
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City | BOCA RATON
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State | FL
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Zip | 33487-8235
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Country | US
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Telephone | 561-677-3133
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Fax | 561-879-4025
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Provider Business Mailing Address
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Address Line | 15251 NE 18TH AVE STE 9
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-6039
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Country | US
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Telephone | 305-627-3103
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALI MANDSOURWALA
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Credential |
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Telephone | 561-677-3133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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