Shanell Clark

Primary specialty

Nursing Home AdministratorTaxonomy code 376G00000X

Practice address

21820 Beverly St
Oak Park, MI 48237-2503

Phone

(248) 234-6150

NPI assigned

Apr 25, 2016

Last updated

Apr 25, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fountain of Love Assisted Living Inc

  • Clinical Social Worker
  • Oak Park, MI
  • NPI 1093021859
  NPD (past) Authorized official
• Fountain of Love Assisted Living Sevices Inc

  dba 4-Wings Transportation

  • Adult Day Care Clinic/Center
  • Oak Park, MI
  • NPI 1497160477
  NPD (past) Authorized official

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

{
    "created_epoch": "1461542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461542400000",
    "number": "1972958106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21820 BEVERLY ST",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482372503",
            "telephone_number": "248-234-6150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21820 BEVERLY ST",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482372503",
            "telephone_number": "248-234-6150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANELL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-25",
        "last_updated": "2016-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "372500000X",
            "taxonomy_group": "",
            "desc": "Chore Provider",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "376G00000X",
            "taxonomy_group": "",
            "desc": "Nursing Home Administrator",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina L Kimbrough PLLC
• Circle of Life
• Aimee Cisler
• Gregory Q. Clague, D.O.
• Shana Clark, RN
• Amanda Clay
• Clear Choice Lab Solutions LLC
• Close Family Home Care, LLC
• Patrice Coates
• Dracy Dejuan Colley

• Nursing Home Administrator in Oak Park, MI
• Providers in Oak Park, MI by specialty
• Nursing Home Administrator in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; 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.