Provider Demographics
NPI:1164726527
Name:SHANGRI-LA HOMES LLC
Entity Type:Organization
Organization Name:SHANGRI-LA HOMES LLC
Other - Org Name:SHANGRI-LA ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-802-9071
Mailing Address - Street 1:4475 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6007
Mailing Address - Country:US
Mailing Address - Phone:443-802-9071
Mailing Address - Fax:410-750-7938
Practice Address - Street 1:4475 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6007
Practice Address - Country:US
Practice Address - Phone:443-802-9071
Practice Address - Fax:410-750-7938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13AL0225310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility