Provider Demographics
NPI:1700066610
Name:EL SHADAI CARE HOME
Entity Type:Organization
Organization Name:EL SHADAI CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:AYORINDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-715-5725
Mailing Address - Street 1:1225 NUTTING ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-8135
Mailing Address - Country:US
Mailing Address - Phone:972-291-7445
Mailing Address - Fax:972-291-3176
Practice Address - Street 1:1225 NUTTING ST
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-8135
Practice Address - Country:US
Practice Address - Phone:972-291-7445
Practice Address - Fax:972-291-3176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121949310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121949OtherASSISTED LIVING HOME