Provider Demographics
NPI:1376188979
Name:SHARED GOALS LLC
Entity Type:Organization
Organization Name:SHARED GOALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORDINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:786-925-3003
Mailing Address - Street 1:8000 EAST DR APT 206
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4161
Mailing Address - Country:US
Mailing Address - Phone:786-925-3003
Mailing Address - Fax:
Practice Address - Street 1:8000 EAST DR APT 206
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4161
Practice Address - Country:US
Practice Address - Phone:786-925-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty