Provider Demographics
NPI:1154936037
Name:SHUJUAN HOLDINGS LLC
Entity type:Organization
Organization Name:SHUJUAN HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAWFORD
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-270-1605
Mailing Address - Street 1:902 W WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3951
Mailing Address - Country:US
Mailing Address - Phone:706-270-1605
Mailing Address - Fax:
Practice Address - Street 1:110 E PACES DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-5217
Practice Address - Country:US
Practice Address - Phone:706-270-1605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAGGART ATLANTIC HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home