MEDICARE: SHELTERING ARMS IN- HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1891573630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELTERING ARMS IN- HOME LLC

Provider Business Mailing Address
First Line	:	3119 W STATE HIGHWAY 84
Second Line	:
City	:	BRAGG CITY
State	:	MO
Zip	:	63827-9179
Country	:	US
Telephone Number	:	573-391-0902
Fax Number	:

Provider Business Practice Location Address
First Line	:	3119 W STATE HIGHWAY 84
Second Line	:
City	:	BRAGG CITY
State	:	MO
Zip	:	63827-9179
Country	:	US
Telephone Number	:	573-391-0902
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TERRY D DAVIS SR.
Credential	:
Telephone Number	:	573-391-0902

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	09/21/2023

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