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
StateLicense IDTaxonomies
NCHC4145251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health