Provider Demographics
NPI:1538464813
Name:EL SHADAI HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:EL SHADAI HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:
Authorized Official - First Name:OLUSOLA
Authorized Official - Middle Name:ADEREMI
Authorized Official - Last Name:AKINGBADE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-801-8511
Mailing Address - Street 1:2904 SHANNON LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8010
Mailing Address - Country:US
Mailing Address - Phone:972-801-8511
Mailing Address - Fax:972-352-5116
Practice Address - Street 1:2904 SHANNON LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8010
Practice Address - Country:US
Practice Address - Phone:972-801-8511
Practice Address - Fax:972-352-5116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health