Provider Demographics
NPI:1124022629
Name:SHELTERING ARMS HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SHELTERING ARMS HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WIEBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-831-5050
Mailing Address - Street 1:2459 WILKINSON BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5669
Mailing Address - Country:US
Mailing Address - Phone:704-731-2403
Mailing Address - Fax:704-749-0476
Practice Address - Street 1:2459 WILKINSON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5669
Practice Address - Country:US
Practice Address - Phone:704-731-2403
Practice Address - Fax:704-731-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAEXEMPT251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124022629Medicaid
VA1124022629Medicaid