Provider Demographics
NPI:1578760187
Name:SHALIMARE INC.
Entity Type:Organization
Organization Name:SHALIMARE INC.
Other - Org Name:SHALIMARE INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT OF SHALIMARE INC.
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PROVENCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-839-4997
Mailing Address - Street 1:613 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-4015
Mailing Address - Country:US
Mailing Address - Phone:239-839-4997
Mailing Address - Fax:239-693-1121
Practice Address - Street 1:613 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-4015
Practice Address - Country:US
Practice Address - Phone:239-839-4997
Practice Address - Fax:239-693-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child