Provider Demographics
NPI:1679161442
Name:SHUNGO CARE LLC
Entity Type:Organization
Organization Name:SHUNGO CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:AYANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:219-902-1138
Mailing Address - Street 1:273 MILBURN AVE
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2312
Mailing Address - Country:US
Mailing Address - Phone:219-902-1138
Mailing Address - Fax:
Practice Address - Street 1:13923 S SCHOOL ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:IL
Practice Address - Zip Code:60827-1915
Practice Address - Country:US
Practice Address - Phone:219-902-1138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility