Provider Demographics
NPI:1952158511
Name:TERESA SHIVERS
Entity type:Organization
Organization Name:TERESA SHIVERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-707-7016
Mailing Address - Street 1:126 FOLK ST UNIT 17
Mailing Address - Street 2:
Mailing Address - City:BRANCHVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29432-2346
Mailing Address - Country:US
Mailing Address - Phone:803-707-7016
Mailing Address - Fax:
Practice Address - Street 1:126 FOLK ST UNIT 17
Practice Address - Street 2:
Practice Address - City:BRANCHVILLE
Practice Address - State:SC
Practice Address - Zip Code:29432-2346
Practice Address - Country:US
Practice Address - Phone:803-707-7016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty