Provider Demographics
NPI:1023768579
Name:THE SHIP GROUP SERVICES LLC
Entity type:Organization
Organization Name:THE SHIP GROUP SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:704-553-5392
Mailing Address - Street 1:PO BOX 42915
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-0017
Mailing Address - Country:US
Mailing Address - Phone:704-553-5392
Mailing Address - Fax:980-333-4063
Practice Address - Street 1:3126 MILTON RD STE 215
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3778
Practice Address - Country:US
Practice Address - Phone:704-553-5392
Practice Address - Fax:980-333-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health