Provider Demographics
NPI:1568655744
Name:SHORE UP INC
Entity Type:Organization
Organization Name:SHORE UP INC
Other - Org Name:WESTOVER ADULT DAY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-749-1142
Mailing Address - Street 1:520 SNOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6031
Mailing Address - Country:US
Mailing Address - Phone:410-749-1142
Mailing Address - Fax:410-472-9191
Practice Address - Street 1:8395 OLD WESTOVER RD
Practice Address - Street 2:
Practice Address - City:WESTOVER
Practice Address - State:MD
Practice Address - Zip Code:21871
Practice Address - Country:US
Practice Address - Phone:410-651-4925
Practice Address - Fax:410-651-4928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHORE UP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0689261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care