Provider Demographics
NPI:1396450615
Name:SHAW HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:SHAW HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHINEEKQUA
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:888-742-9427
Mailing Address - Street 1:500 GROSSMAN DR # 1007
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4953
Mailing Address - Country:US
Mailing Address - Phone:857-615-6490
Mailing Address - Fax:
Practice Address - Street 1:500 GROSSMAN DR # 1007
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4953
Practice Address - Country:US
Practice Address - Phone:857-615-6490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001620530OtherHOME CARE AGENCY