Provider Demographics
NPI:1477430759
Name:SHADY PINES MA INC.
Entity type:Organization
Organization Name:SHADY PINES MA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:IGBANOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-316-8727
Mailing Address - Street 1:426 W GAY ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2801
Mailing Address - Country:US
Mailing Address - Phone:484-639-9997
Mailing Address - Fax:
Practice Address - Street 1:426 W GAY ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2801
Practice Address - Country:US
Practice Address - Phone:484-639-9997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care