Provider Demographics
NPI:1811226368
Name:SHIRLEY MEADOWS
Entity Type:Organization
Organization Name:SHIRLEY MEADOWS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-939-9934
Mailing Address - Street 1:247 KYLE MAC WAY RD
Mailing Address - Street 2:
Mailing Address - City:RUFFIN
Mailing Address - State:NC
Mailing Address - Zip Code:27326-9602
Mailing Address - Country:US
Mailing Address - Phone:336-939-9934
Mailing Address - Fax:
Practice Address - Street 1:247 KYLE MAC WAY RD
Practice Address - Street 2:
Practice Address - City:RUFFIN
Practice Address - State:NC
Practice Address - Zip Code:27326-9602
Practice Address - Country:US
Practice Address - Phone:336-939-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care