Healthcare Provider Details

I. General information

NPI: 1144369224
Provider Name (Legal Business Name): SHINING HOPE FARMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 WHIPPOORWILL LN
MOUNT HOLLY NC
28120-9765
US

IV. Provider business mailing address

PO BOX 1036
MOUNT HOLLY NC
28120-1036
US

V. Phone/Fax

Practice location:
  • Phone: 704-827-3788
  • Fax: 704-827-3799
Mailing address:
  • Phone: 704-827-3788
  • Fax: 704-827-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNC
# 8
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MILINDA HENDRICK KIRKPATRICK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-827-3788