Provider Demographics
NPI:1114255452
Name:THE SHEPHERDS MISSION INC
Entity Type:Organization
Organization Name:THE SHEPHERDS MISSION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANIQUE
Authorized Official - Middle Name:WASHINGTON
Authorized Official - Last Name:SMALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:336-772-2697
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27323-0254
Mailing Address - Country:US
Mailing Address - Phone:336-772-2697
Mailing Address - Fax:
Practice Address - Street 1:2303 S HOLDEN RD
Practice Address - Street 2:APT 103K
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-5953
Practice Address - Country:US
Practice Address - Phone:336-772-2697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health