Healthcare Provider Details

I. General information

NPI: 1982739090
Provider Name (Legal Business Name): SHORE UP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SNOW HILL RD
SALISBURY MD
21804-6031
US

IV. Provider business mailing address

520 SNOW HILL RD
SALISBURY MD
21804-6031
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-1142
  • Fax: 410-742-9191
Mailing address:
  • Phone: 410-749-1142
  • Fax: 410-742-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. FREDDY L MITCHELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-749-1142