MEDICARE: SHARED LIVING 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	:	1578328050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARED LIVING LLC

Provider Business Mailing Address
First Line	:	4124 SACKETT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1289
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4124 SACKETT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1289
Country	:	US
Telephone Number	:	240-353-6579
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BIGIRIMANA DANISA
Credential	:
Telephone Number	:	240-353-6579

Provider Enumeration Date	:	02/14/2024
Last Update Date	:	02/14/2024

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Directions to “SHARED LIVING LLC ” Practice Location

Language	Start Address	Practice Location

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