Provider Demographics
NPI:1851507370
Name:MY SHEPHARDS DEN INC
Entity Type:Organization
Organization Name:MY SHEPHARDS DEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-822-0748
Mailing Address - Street 1:112 HILLCREST DR.
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-2307
Mailing Address - Country:US
Mailing Address - Phone:704-822-0748
Mailing Address - Fax:704-822-9072
Practice Address - Street 1:112 HILLCREST DR
Practice Address - Street 2:112HILLCREST DR.
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-2307
Practice Address - Country:US
Practice Address - Phone:704-822-0748
Practice Address - Fax:704-822-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3524251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health