Healthcare Provider Details

I. General information

NPI: 1568655744
Provider Name (Legal Business Name): SHORE UP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

8395 OLD WESTOVER RD
WESTOVER MD
21871
US

IV. Provider business mailing address

520 SNOW HILL RD
SALISBURY MD
21804-6031
US

V. Phone/Fax

Practice location:
  • Phone: 410-651-4925
  • Fax: 410-651-4928
Mailing address:
  • Phone: 410-749-1142
  • Fax: 410-472-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number0689
License Number StateMD

VIII. Authorized Official

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