Provider Demographics
NPI:1225359300
Name:SHORE HOME CARE AGENCY, INC.
Entity Type:Organization
Organization Name:SHORE HOME CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-765-3635
Mailing Address - Street 1:3410 HEALY DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1403
Mailing Address - Country:US
Mailing Address - Phone:336-765-3635
Mailing Address - Fax:336-765-0736
Practice Address - Street 1:3410 HEALY DR
Practice Address - Street 2:SUITE 211
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1403
Practice Address - Country:US
Practice Address - Phone:336-765-3635
Practice Address - Fax:336-765-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health