MEDICARE: SHAPC 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	251G00000X	Community Based Hospice Care Agency	HSPC3731	AZ

General Provider Information

NPI Number	:	1912969387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAPC LLC

Provider Business Mailing Address
First Line	:	450 S 900 E STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2983
Country	:	US
Telephone Number	:	801-485-6166
Fax Number	:	801-531-1949

Provider Business Practice Location Address
First Line	:	10150 W DESERT RIVER BLVD STE A-110
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85307-3008
Country	:	US
Telephone Number	:	602-216-2273
Fax Number	:	602-443-5398

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	KENNETH E NORRIS
Credential	:
Telephone Number	:	801-485-6166

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	03/30/2021

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