Healthcare Provider Details

I. General information

NPI: 1831573385
Provider Name (Legal Business Name): SHOEMAKER HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 N SETH CHILD RD SUITE 140
MANHATTAN KS
66503-8817
US

IV. Provider business mailing address

2401 N SETH CHILD RD SUITE 140
MANHATTAN KS
66503-8817
US

V. Phone/Fax

Practice location:
  • Phone: 785-473-7007
  • Fax: 785-370-0524
Mailing address:
  • Phone: 785-473-7007
  • Fax: 785-370-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA081009
License Number StateKS

VIII. Authorized Official

Name: ELWOOD SHOEMAKER
Title or Position: OWNER
Credential:
Phone: 785-473-7007