Healthcare Provider Details

I. General information

NPI: 1083178818
Provider Name (Legal Business Name): SHOALS NP HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11493 RIVER RD
TOWN CREEK AL
35672-9027
US

IV. Provider business mailing address

11493 RIVER RD
TOWN CREEK AL
35672-9027
US

V. Phone/Fax

Practice location:
  • Phone: 256-627-5300
  • Fax:
Mailing address:
  • Phone: 256-627-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAWN SEAL
Title or Position: EXECUTIVE OFFICER
Credential: CRNP
Phone: 256-627-5300