Provider Demographics
NPI:1861013138
Name:HAMPTON, SHIRLEY C
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:C
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NC
Mailing Address - Zip Code:27013-0081
Mailing Address - Country:US
Mailing Address - Phone:704-433-5060
Mailing Address - Fax:
Practice Address - Street 1:210 CLEMENT ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NC
Practice Address - Zip Code:27013
Practice Address - Country:US
Practice Address - Phone:704-433-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5406253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care