Healthcare Provider Details

I. General information

NPI: 1518027986
Provider Name (Legal Business Name): SHFP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3706 OLD BATTLEGROUND RD
GREENSBORO NC
27410
US

IV. Provider business mailing address

3706 OLD BATTLEGROUND RD
GREENSBORO NC
27410
US

V. Phone/Fax

Practice location:
  • Phone: 336-286-6400
  • Fax: 336-739-4166
Mailing address:
  • Phone: 336-286-6400
  • Fax: 336-739-4166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberMHL-041-654
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-041-773
License Number StateNC

VIII. Authorized Official

Name: GINA TANNER
Title or Position: DIRECTOR, QP
Credential:
Phone: 336-286-6400