Provider Demographics
NPI:1891164828
Name:SHADAI HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:SHADAI HEALTHCARE SERVICES LLC
Other - Org Name:SHADAI HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSU
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:717-379-3269
Mailing Address - Street 1:22 N 32ND STREET
Mailing Address - Street 2:22 & 24
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011
Mailing Address - Country:US
Mailing Address - Phone:717-303-0272
Mailing Address - Fax:717-303-0273
Practice Address - Street 1:22 N 32ND STREET
Practice Address - Street 2:22 & 24
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2917
Practice Address - Country:US
Practice Address - Phone:717-303-0272
Practice Address - Fax:717-303-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA06070501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health