Provider Demographics
NPI:1457582165
Name:MY SHEPHERDS DEN HOME HEALTH
Entity Type:Organization
Organization Name:MY SHEPHERDS DEN HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LINDA S. JONES
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-822-0748
Mailing Address - Street 1:5803 W WILKINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-4809
Mailing Address - Country:US
Mailing Address - Phone:704-822-9072
Mailing Address - Fax:
Practice Address - Street 1:5803 W WILKINSON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-4810
Practice Address - Country:US
Practice Address - Phone:704-822-9072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3524251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health