Shady Rest Residential Facility

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

SHADY REST RESIDENTIAL FACILITY

Practice address

343 Texas Ave
Mt Laurel, NJ 08054-0805

Phone

(856) 668-6610

Fax

(856) 668-6610

NPI assigned

Dec 5, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dioun Young

Title

Owner

Phone

(856) 668-6610

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512432000000",
    "number": "1003321654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 TEXAS AVE",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080543510",
            "telephone_number": "856-668-6610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 TEXAS AVE",
            "city": "MT LAUREL",
            "state": "NJ",
            "postal_code": "080540805",
            "telephone_number": "856-668-6610",
            "fax_number": "856-668-6610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY REST RESIDENTIAL FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-05",
        "last_updated": "2017-12-05",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "DIOUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-668-6610"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hyoung Suk Seo, D.M.D
• Wansuk Seth Seo, D.M.D.
• Jennifer Sepede, D.O.
• Reema Sethi, BCBA
• Fatemah Shabbir
• Gopi Shah, LAC
• Priya Shah, D.O.
• Rinaben R Shah, PHYSICAL THERAPIST
• Gary I Shapiro, MD
• Mark Ellis Shapiro, R.PH. B.SC.

• In Home Supportive Care Agency in Mt Laurel, NJ
• Providers in Mt Laurel, NJ by specialty
• In Home Supportive Care Agency in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.