Provider Demographics
NPI:1649696899
Name:SHELBY HEALTH CARE SERVICES; LLC
Entity type:Organization
Organization Name:SHELBY HEALTH CARE SERVICES; LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CHINEDU
Authorized Official - Last Name:NJOKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-523-9873
Mailing Address - Street 1:12624 TROTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-6304
Mailing Address - Country:US
Mailing Address - Phone:301-523-9873
Mailing Address - Fax:
Practice Address - Street 1:12624 TROTWOOD CT
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-6304
Practice Address - Country:US
Practice Address - Phone:301-523-9873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3322251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health