Provider Demographics
NPI:1073708491
Name:SHRIDAYAL LLC
Entity type:Organization
Organization Name:SHRIDAYAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIGOZIE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:OGWUEGBU-STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:JD/MBA
Authorized Official - Phone:704-510-0030
Mailing Address - Street 1:1324 JOHN KIRK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0824
Mailing Address - Country:US
Mailing Address - Phone:704-510-0030
Mailing Address - Fax:704-510-5331
Practice Address - Street 1:1324 JOHN KIRK DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-0824
Practice Address - Country:US
Practice Address - Phone:704-510-0030
Practice Address - Fax:704-510-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC385H00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite Care