MEDICARE: SHIVAWN INC.

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1366883951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIVAWN INC.

Provider Business Mailing Address
First Line	:	6422 FERNE AVE
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-4818
Country	:	US
Telephone Number	:	714-747-9111
Fax Number	:	888-506-1966

Provider Business Practice Location Address
First Line	:	12062 VALLEY VIEW ST STE 205
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-1739
Country	:	US
Telephone Number	:	714-747-9111
Fax Number	:	888-506-1966

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID SANDHU
Credential	:	RN, BSN, PHN, CCM
Telephone Number	:	714-747-9111

Provider Enumeration Date	:	07/11/2013
Last Update Date	:	07/11/2013

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