MEDICARE: SHIRAZ, 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	261QA0600X	Adult Day Care Clinic/Center		CA

General Provider Information

NPI Number	:	1639293640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIRAZ, INC.

Provider Business Mailing Address
First Line	:	6907 LANKERSHIM BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-6111
Country	:	US
Telephone Number	:	818-764-3336
Fax Number	:	818-764-6336

Provider Business Practice Location Address
First Line	:	6907 LANKERSHIM BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-6111
Country	:	US
Telephone Number	:	818-764-3336
Fax Number	:	818-764-6336

Authorized Official
Title or Position	:	CFO
Name	:	MR. OLEG PILLER
Credential	:
Telephone Number	:	818-764-3336

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	09/07/2007

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