Provider Demographics
NPI:1114049780
Name:SHEPHERD SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:SHEPHERD SUPPORT SERVICES, LLC
Other - Org Name:ADULT TENDERCARE CENTER - MONETT CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:417-489-6300
Mailing Address - Street 1:3351 W DRIFTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8151
Mailing Address - Country:US
Mailing Address - Phone:417-866-1559
Mailing Address - Fax:417-823-0716
Practice Address - Street 1:1010 OLD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-9182
Practice Address - Country:US
Practice Address - Phone:417-236-0199
Practice Address - Fax:417-236-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO690261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care