Healthcare Provider Details

I. General information

NPI: 1972817666
Provider Name (Legal Business Name): SHIPMAN-MONTGOMERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 NORTH MAIN STREET
MT. GILEAD NC
27306
US

IV. Provider business mailing address

1614 E MARKET ST
GREENSBORO NC
27401-3210
US

V. Phone/Fax

Practice location:
  • Phone: 910-439-5890
  • Fax: 910-439-5918
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 NumberHC2905
License Number StateNC

VIII. Authorized Official

Name: MS. GLADYS F SHIPMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-272-7545