Shangrila Home

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

License

AF110000791 Issued in MI

Legal business name

SHANGRILA HOME

Practice address

8876 Kephart LN
Berrien Springs, MI 49103-1440

Phone

(269) 473-7000

Fax

(269) 473-8876

NPI assigned

Mar 31, 2015

Last updated

Mar 31, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dyan A Lee

Title

General Manager

Phone

(269) 473-7000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427760000000",
    "number": "1982099586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8876 KEPHART LN",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491031440",
            "telephone_number": "269-473-7000",
            "fax_number": "269-473-8876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8876 KEPHART LN",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491031440",
            "telephone_number": "269-473-7000",
            "fax_number": "269-473-8876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANGRILA HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-31",
        "last_updated": "2015-03-31",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "DYAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "269-473-7000"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "MI",
            "license": "AF110000791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Herbert Schug, BS RPH
• Kevin Seo, MD
• Robert Sepulveda, LPC
• Kathleen Joann Shafer, LMSW
• Rahul Chaitanya Shah
• Lars Sherburn
• Jane Anne Sherwin, RN
• Crystal Smeal
• Chana Ione Smith, PT
• Harold B Smith, PYS.D.

• Custodial Care Facility in Berrien Springs, MI
• Providers in Berrien Springs, MI by specialty
• Custodial Care Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.