Provider Demographics
NPI:1811465974
Name:SHI-III WRENTHAM LLC
Entity type:Organization
Organization Name:SHI-III WRENTHAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DIOGUARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-496-1505
Mailing Address - Street 1:100 JERICHO QUADRANGLE STE 142
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2702
Mailing Address - Country:US
Mailing Address - Phone:516-496-1505
Mailing Address - Fax:516-496-1509
Practice Address - Street 1:30 LEDGEVIEW WAY
Practice Address - Street 2:ATTN: EXECUTIVE DIRECTOR OR DBA
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093
Practice Address - Country:US
Practice Address - Phone:774-210-8108
Practice Address - Fax:774-847-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility