Provider Demographics
NPI:1033796263
Name:NADINE P SHAW
Entity type:Organization
Organization Name:NADINE P SHAW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:719-306-9512
Mailing Address - Street 1:4411 HICKORY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3496
Mailing Address - Country:US
Mailing Address - Phone:719-306-9512
Mailing Address - Fax:
Practice Address - Street 1:4411 HICKORY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3496
Practice Address - Country:US
Practice Address - Phone:719-306-9512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty