Provider Demographics
NPI:1639293640
Name:SHIRAZ, INC.
Entity Type:Organization
Organization Name:SHIRAZ, INC.
Other - Org Name:SHIRAZ ADHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-764-3336
Mailing Address - Street 1:6907 LANKERSHIM BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-6111
Mailing Address - Country:US
Mailing Address - Phone:818-764-3336
Mailing Address - Fax:818-764-6336
Practice Address - Street 1:6907 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-6111
Practice Address - Country:US
Practice Address - Phone:818-764-3336
Practice Address - Fax:818-764-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care