Provider Demographics
NPI: | 1477867802 |
---|---|
Name: | SHIPMAN-FAYETTEVILLE |
Entity Type: | Organization |
Organization Name: | SHIPMAN-FAYETTEVILLE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | GLADYS |
Authorized Official - Middle Name: | F |
Authorized Official - Last Name: | SHIPMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 336-272-7545 |
Mailing Address - Street 1: | 1614 E MARKET ST |
Mailing Address - Street 2: | |
Mailing Address - City: | GREENSBORO |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27401-3210 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 336-272-7919 |
Mailing Address - Fax: | 336-272-0612 |
Practice Address - Street 1: | 930 CAMBRIDGE ST |
Practice Address - Street 2: | STE 200 |
Practice Address - City: | FAYETTEVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28303-9625 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-321-1047 |
Practice Address - Fax: | 910-321-1049 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | SHIPMAN FAMILY HOME CARE, INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2010-07-27 |
Last Update Date: | 2010-07-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | HC4145 | 251E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |