Provider Demographics
NPI:1972143709
Name:THE SHEPHERD'S HOUSE A RECOVERY PROGRAM
Entity Type:Organization
Organization Name:THE SHEPHERD'S HOUSE A RECOVERY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STRADWICK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:304-840-3457
Mailing Address - Street 1:PO BOX 2521
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25726-2521
Mailing Address - Country:US
Mailing Address - Phone:304-521-3226
Mailing Address - Fax:304-523-0932
Practice Address - Street 1:1650 8TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1702
Practice Address - Country:US
Practice Address - Phone:304-697-3007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALT OF THE WORLD MINISTRIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No177F00000XOther Service ProvidersLodging
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle