Provider Demographics
NPI:1710519046
Name:SHAW COMMUNITY INTEGRATION SERVICES
Entity Type:Organization
Organization Name:SHAW COMMUNITY INTEGRATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-952-1965
Mailing Address - Street 1:8119 S VERNON AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-4913
Mailing Address - Country:US
Mailing Address - Phone:773-952-1965
Mailing Address - Fax:708-810-9792
Practice Address - Street 1:8119 S VERNON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-4913
Practice Address - Country:US
Practice Address - Phone:773-952-1965
Practice Address - Fax:708-810-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty