Provider Demographics
NPI:1114024858
Name:SHEPARDS CROOK NURSING AGENCY, INC.
Entity Type:Organization
Organization Name:SHEPARDS CROOK NURSING AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:806-665-0356
Mailing Address - Street 1:PO BOX 2234
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79066-2234
Mailing Address - Country:US
Mailing Address - Phone:806-665-0356
Mailing Address - Fax:806-665-4245
Practice Address - Street 1:916 CREST RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065
Practice Address - Country:US
Practice Address - Phone:806-665-0356
Practice Address - Fax:806-665-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001993251E00000X
TX1993251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677188Medicare PIN