Healthcare Provider Details

I. General information

NPI: 1558675975
Provider Name (Legal Business Name): SHIPMAN FAMILY CARE HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 UNIVERSITY DR STE A
DURHAM NC
27707-3774
US

IV. Provider business mailing address

1614 E MARKET ST
GREENSBORO NC
27401-3210
US

V. Phone/Fax

Practice location:
  • Phone: 919-908-1204
  • Fax: 919-908-1302
Mailing address:
  • Phone: 336-272-7919
  • Fax: 336-272-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2569
License Number StateNC

VIII. Authorized Official

Name: MS. TREVA MCINTYRE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-272-7545