Provider Demographics
NPI:1669268132
Name:SHELLIS PRIVATE HOME CARE LLC
Entity type:Organization
Organization Name:SHELLIS PRIVATE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGHANN
Authorized Official - Middle Name:SOPHIA
Authorized Official - Last Name:SHERROD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:912-685-2216
Mailing Address - Street 1:2340 SOUTHERN MANOR RD
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-7613
Mailing Address - Country:US
Mailing Address - Phone:912-685-2216
Mailing Address - Fax:
Practice Address - Street 1:2340 SOUTHERN MANOR RD
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-7613
Practice Address - Country:US
Practice Address - Phone:912-685-2216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty