Provider Demographics
NPI:1023992104
Name:SHIMONE ANTONYA LLC
Entity type:Organization
Organization Name:SHIMONE ANTONYA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-879-3154
Mailing Address - Street 1:6220 MOUNTIE WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9410
Mailing Address - Country:US
Mailing Address - Phone:517-879-3154
Mailing Address - Fax:
Practice Address - Street 1:6220 MOUNTIE WAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-9410
Practice Address - Country:US
Practice Address - Phone:517-879-3154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-02
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals