MEDICARE: SHIV ENTERPRISE GROUP 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	253Z00000X	In Home Supportive Care Agency	IHCP0599	SC

General Provider Information

NPI Number	:	1447705751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIV ENTERPRISE GROUP LLC

Provider Business Mailing Address
First Line	:	2411 N OAK ST
Second Line	:	105-B
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3173
Country	:	US
Telephone Number	:	732-522-3724
Fax Number	:

Provider Business Practice Location Address
First Line	:	2411 N OAK ST
Second Line	:	105-B
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3173
Country	:	US
Telephone Number	:	732-522-3724
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NITIN SHAH
Credential	:
Telephone Number	:	732-522-3724

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	08/17/2016

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