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General NPI Number Information
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NPI Number | 1669280061
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Entity Type | Organization
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Legal Business Name | SHAH-NI-4 INC.
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 4354 N CENTRAL AVE STE D
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City | CHICAGO
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State | IL
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Zip | 60634-5600
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Country | US
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Telephone | 224-251-8432
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Fax | 224-251-8319
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Provider Business Mailing Address
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Address Line | 125 FAIRFIELD WAY STE 104
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1556
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Country | US
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Telephone | 224-251-8432
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | RAQIB SHAHZAD
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Credential |
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Telephone | 224-251-8432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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