Provider Demographics
NPI:1356156186
Name:SHAN GROUP 4 LLC
Entity type:Organization
Organization Name:SHAN GROUP 4 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDSOURWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-677-3133
Mailing Address - Street 1:15251 NE 18TH AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-6039
Mailing Address - Country:US
Mailing Address - Phone:305-627-3103
Mailing Address - Fax:
Practice Address - Street 1:621 NW 53RD ST 125
Practice Address - Street 2:OFFICE18
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-8235
Practice Address - Country:US
Practice Address - Phone:561-677-3133
Practice Address - Fax:561-879-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care