Provider Demographics
NPI:1750058780
Name:SHADES OF LIFE HOME HEALTH LLC
Entity Type:Organization
Organization Name:SHADES OF LIFE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLAENCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SEROBYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-271-9299
Mailing Address - Street 1:16501 VENTURA BLVD STE 464
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2007
Mailing Address - Country:US
Mailing Address - Phone:818-562-0587
Mailing Address - Fax:
Practice Address - Street 1:16501 VENTURA BLVD STE 464
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2007
Practice Address - Country:US
Practice Address - Phone:818-562-0587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health