Provider Demographics
NPI:1538286679
Name:SHAKE-A-LEG, INC.
Entity Type:Organization
Organization Name:SHAKE-A-LEG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHARNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-849-8898
Mailing Address - Street 1:850 AQUIDNECK AVE
Mailing Address - Street 2:SUITE 6-A
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-7244
Mailing Address - Country:US
Mailing Address - Phone:401-849-8898
Mailing Address - Fax:401-848-9072
Practice Address - Street 1:850 AQUIDNECK AVE
Practice Address - Street 2:SUITE 6-A
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7244
Practice Address - Country:US
Practice Address - Phone:401-849-8898
Practice Address - Fax:401-848-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISA61623Medicaid