Provider Demographics
NPI:1073378170
Name:SHADES FRIENDLY LIVING LLC
Entity Type:Organization
Organization Name:SHADES FRIENDLY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABUBAKARR
Authorized Official - Middle Name:GEORGE BOCKARE
Authorized Official - Last Name:SILLAH
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:614-598-3311
Mailing Address - Street 1:2417 SE 8TH LN UNIT 31
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-4241
Mailing Address - Country:US
Mailing Address - Phone:614-598-3311
Mailing Address - Fax:
Practice Address - Street 1:519 17TH ST SE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-6011
Practice Address - Country:US
Practice Address - Phone:614-598-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty