Provider Demographics
NPI:1659247906
Name:SHARED SPACES LLC
Entity type:Organization
Organization Name:SHARED SPACES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-319-8130
Mailing Address - Street 1:42105 W CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-3356
Mailing Address - Country:US
Mailing Address - Phone:602-319-8130
Mailing Address - Fax:520-568-2709
Practice Address - Street 1:42105 W CHEYENNE DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-3356
Practice Address - Country:US
Practice Address - Phone:602-319-8130
Practice Address - Fax:520-568-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility