Provider Demographics
NPI:1326696840
Name:SHILOH HEALTHCARE LLC
Entity Type:Organization
Organization Name:SHILOH HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:KIBET
Authorized Official - Last Name:CHEPKOIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-344-4694
Mailing Address - Street 1:5100 BUCKEYSTOWN PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8344
Mailing Address - Country:US
Mailing Address - Phone:240-344-4694
Mailing Address - Fax:240-215-6511
Practice Address - Street 1:5100 BUCKEYSTOWN PIKE STE 250
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8344
Practice Address - Country:US
Practice Address - Phone:240-344-4694
Practice Address - Fax:240-215-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD712902500Medicaid