Provider Demographics
NPI:1982115291
Name:THE SHEPHERD'S HOUSE OF TENDER CARE
Entity Type:Organization
Organization Name:THE SHEPHERD'S HOUSE OF TENDER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:803-398-7982
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924-0014
Mailing Address - Country:US
Mailing Address - Phone:803-398-7982
Mailing Address - Fax:
Practice Address - Street 1:103 HOLLY ST E
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924-3913
Practice Address - Country:US
Practice Address - Phone:803-398-7982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC253Z00000XMedicaid