Provider Demographics
NPI:1730489360
Name:SHEPHERD'S HOME CARE
Entity Type:Organization
Organization Name:SHEPHERD'S HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMIN
Authorized Official - Phone:704-267-3414
Mailing Address - Street 1:1953 JAKE ALEXANDER BLVD W
Mailing Address - Street 2:D
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1166
Mailing Address - Country:US
Mailing Address - Phone:704-680-4321
Mailing Address - Fax:704-680-4321
Practice Address - Street 1:1953 W JAKE ALEXANDER BLVD
Practice Address - Street 2:2
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147
Practice Address - Country:US
Practice Address - Phone:704-680-4321
Practice Address - Fax:704-680-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health