Provider Demographics
NPI:1982409090
Name:SHAH-NI-4 INC.
Entity type:Organization
Organization Name:SHAH-NI-4 INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAQIB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHZAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-251-8432
Mailing Address - Street 1:8605 N SHERMER RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2140
Mailing Address - Country:US
Mailing Address - Phone:224-251-8432
Mailing Address - Fax:224-251-8319
Practice Address - Street 1:125 FAIRFIELD WAY STE 104
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1556
Practice Address - Country:US
Practice Address - Phone:224-251-8432
Practice Address - Fax:224-251-8319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2309759Medicaid