Provider Demographics
NPI:1750073953
Name:INTERCEDE AT HOME
Entity type:Organization
Organization Name:INTERCEDE AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-277-0800
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28026-0995
Mailing Address - Country:US
Mailing Address - Phone:754-277-0800
Mailing Address - Fax:
Practice Address - Street 1:4242 LONG ARROW DRIVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:754-277-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care