MEDICARE: SHANAHAN HOLDINGS, 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	251E00000X	Home Health Agency	011958	TX

General Provider Information

NPI Number	:	1588833578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANAHAN HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	2300 VALLEY VIEW LN
Second Line	:	SUITE 603
City	:	IRVING
State	:	TX
Zip	:	75062-5056
Country	:	US
Telephone Number	:	972-823-1333
Fax Number	:	972-823-1336

Provider Business Practice Location Address
First Line	:	2300 VALLEY VIEW LN
Second Line	:	SUITE 603
City	:	IRVING
State	:	TX
Zip	:	75062-5056
Country	:	US
Telephone Number	:	972-823-1333
Fax Number	:	972-823-1336

Authorized Official
Title or Position	:	OWNER / AGENCY DIRECTOR
Name	:	MR. PATRICK JOSEPH SHANAHAN
Credential	:
Telephone Number	:	972-823-1335

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	04/29/2008

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