Provider Demographics
NPI:1245559921
Name:GOOD SHEPARD IN HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:GOOD SHEPARD IN HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-494-8712
Mailing Address - Street 1:8424 OLD STATESVILLE RD.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-2129
Mailing Address - Country:US
Mailing Address - Phone:704-494-8712
Mailing Address - Fax:704-494-8713
Practice Address - Street 1:8424 OLD STATESVILLE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-2128
Practice Address - Country:US
Practice Address - Phone:704-494-8712
Practice Address - Fax:704-494-8713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3426251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601534Medicaid