Provider Demographics
NPI:1235493560
Name:SHA JA PERSONAL SUPPOURT ASSISTANCE SERVICES LLC
Entity Type:Organization
Organization Name:SHA JA PERSONAL SUPPOURT ASSISTANCE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:AWUSA
Authorized Official - Last Name:ESENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-853-7480
Mailing Address - Street 1:2529 STONE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-6875
Mailing Address - Country:US
Mailing Address - Phone:972-853-7480
Mailing Address - Fax:972-853-7482
Practice Address - Street 1:2529 STONE MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-6875
Practice Address - Country:US
Practice Address - Phone:972-853-7480
Practice Address - Fax:972-853-7482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health