MEDICARE: SHANGRI-LA ALF 868 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1114878626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANGRI-LA ALF 868 LLC

Provider Business Mailing Address
First Line	:	868 RIVIERA DR NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4438
Country	:	US
Telephone Number	:	321-432-0675
Fax Number	:

Provider Business Practice Location Address
First Line	:	868 RIVIERA DR NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4438
Country	:	US
Telephone Number	:	321-432-0675
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANKUR SHAH
Credential	:
Telephone Number	:	321-432-0675

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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