Provider Demographics
NPI:1760215396
Name:SHROUDED VALLEY ENTERPRISES INC
Entity type:Organization
Organization Name:SHROUDED VALLEY ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHROUDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-484-4866
Mailing Address - Street 1:24 VETERANS SQ
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3155
Mailing Address - Country:US
Mailing Address - Phone:610-484-4866
Mailing Address - Fax:
Practice Address - Street 1:24 VETERANS SQ
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3155
Practice Address - Country:US
Practice Address - Phone:610-484-4866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care