Provider Demographics
NPI:1841504289
Name:SHIPMAN FAMILY CARE HOME INC.
Entity type:Organization
Organization Name:SHIPMAN FAMILY CARE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TREVA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-272-7545
Mailing Address - Street 1:1614 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-3210
Mailing Address - Country:US
Mailing Address - Phone:336-272-7919
Mailing Address - Fax:336-272-0612
Practice Address - Street 1:163 STRATFORD CT STE 115
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1875
Practice Address - Country:US
Practice Address - Phone:336-722-7466
Practice Address - Fax:704-374-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3810251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health