Provider Demographics
NPI:1639489198
Name:SHIROSE LLC
Entity Type:Organization
Organization Name:SHIROSE LLC
Other - Org Name:ARBOR MANOR ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSITRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:S
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-257-3629
Mailing Address - Street 1:6749 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4844
Mailing Address - Country:US
Mailing Address - Phone:954-989-8137
Mailing Address - Fax:954-239-8310
Practice Address - Street 1:6749 ARBOR DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-4844
Practice Address - Country:US
Practice Address - Phone:954-989-8137
Practice Address - Fax:954-239-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11811310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility