Shangri-la, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

2473 Issued in VA

Legal business name

SHANGRI-LA, LLC

Practice address

3650 Butor Rd
North Prince George, VA 23860-7429

Phone

(804) 541-3589

NPI assigned

Mar 14, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Loretta Faulknier

Title

Chief Executive Officer

Phone

(804) 541-3589

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1426291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426291200000",
    "number": "1902299985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1014",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238750961",
            "telephone_number": "804-541-3589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 BUTOR RD",
            "city": "NORTH PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238607429",
            "telephone_number": "804-541-3589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANGRI-LA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-14",
        "last_updated": "2015-03-14",
        "status": "A",
        "authorized_official_last_name": "FAULKNIER",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "804-541-3589",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "2473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Prince George, VA
• Providers in North Prince George, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2015; 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.