Provider Demographics
NPI:1538325592
Name:THE SHEPHERD'S HOUSE FOR SERVICES TO THE COMMUNITY
Entity Type:Organization
Organization Name:THE SHEPHERD'S HOUSE FOR SERVICES TO THE COMMUNITY
Other - Org Name:THE SHEPHERD'S HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCELLETTE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:ORANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-251-3837
Mailing Address - Street 1:5250 IVY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-5908
Mailing Address - Country:US
Mailing Address - Phone:336-251-3837
Mailing Address - Fax:336-768-0023
Practice Address - Street 1:1001 S MARSHALL ST
Practice Address - Street 2:SUITE 2-18
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5852
Practice Address - Country:US
Practice Address - Phone:336-251-3837
Practice Address - Fax:336-768-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health