Provider Demographics
NPI:1912573965
Name:SHC 2021 LLC
Entity type:Organization
Organization Name:SHC 2021 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-488-2036
Mailing Address - Street 1:2403 AIR CARGO DR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-8944
Mailing Address - Country:US
Mailing Address - Phone:406-488-2036
Mailing Address - Fax:
Practice Address - Street 1:544 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3638
Practice Address - Country:US
Practice Address - Phone:406-488-2117
Practice Address - Fax:406-488-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport