Provider Demographics
NPI:1578150462
Name:HIS SHADOW SERVICES LLC
Entity Type:Organization
Organization Name:HIS SHADOW SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:EZE
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUNNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-305-8090
Mailing Address - Street 1:3007 ROSE TRACE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3895
Mailing Address - Country:US
Mailing Address - Phone:432-305-8090
Mailing Address - Fax:
Practice Address - Street 1:3007 ROSE TRACE DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-3895
Practice Address - Country:US
Practice Address - Phone:432-305-8090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty