Provider Demographics
NPI:1003924283
Name:SHIRLEY HARDEN MERRITT
Entity Type:Organization
Organization Name:SHIRLEY HARDEN MERRITT
Other - Org Name:ELDERLY AND INDEPENDENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:HARDEN
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:770-207-5426
Mailing Address - Street 1:PO BOX 703
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-0703
Mailing Address - Country:US
Mailing Address - Phone:770-207-5426
Mailing Address - Fax:
Practice Address - Street 1:122 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-5276
Practice Address - Country:US
Practice Address - Phone:770-207-5426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health