Provider Demographics
NPI:1356025605
Name:A SHEPHERDS PROVISION LLC
Entity type:Organization
Organization Name:A SHEPHERDS PROVISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HERVE
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:GAILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-220-6442
Mailing Address - Street 1:5874 BROOKSTONE DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-2535
Mailing Address - Country:US
Mailing Address - Phone:908-220-6442
Mailing Address - Fax:
Practice Address - Street 1:5874 BROOKSTONE DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2535
Practice Address - Country:US
Practice Address - Phone:908-220-6442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker