Healthcare Provider Details

I. General information

NPI: 1710531769
Provider Name (Legal Business Name): SHEPHERD HOME HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12715 CLOCK TOWER PKWY
HUDSON FL
34667-2504
US

IV. Provider business mailing address

12715 CLOCK TOWER PKWY
HUDSON FL
34667-2504
US

V. Phone/Fax

Practice location:
  • Phone: 954-274-9113
  • Fax: 866-924-5296
Mailing address:
  • Phone: 954-274-9113
  • Fax: 866-924-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARTIALE FAUSTIN
Title or Position: CEO
Credential: RN
Phone: 954-274-9113