Provider Demographics
NPI:1669422853
Name:SHORE LIFECARE, INC.
Entity type:Organization
Organization Name:SHORE LIFECARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP/CFO/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-531-7015
Mailing Address - Street 1:608 DENBIGH BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4411
Mailing Address - Country:US
Mailing Address - Phone:757-875-2023
Mailing Address - Fax:757-875-2016
Practice Address - Street 1:26181 PARKSLEY RD
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421-3723
Practice Address - Country:US
Practice Address - Phone:757-665-5133
Practice Address - Fax:757-665-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2475313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1273950001OtherDURABLE MED EQUIPMENT
VA004953347Medicaid
VA1273950001OtherDURABLE MED EQUIPMENT