Healthcare Provider Details

I. General information

NPI: 1780951426
Provider Name (Legal Business Name): R & L SHORTER AND ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1988 FAYETTEVILLE RD
RAEFORD NC
28376
US

IV. Provider business mailing address

116 GRANGER RD
RAEFORD NC
28376-8060
US

V. Phone/Fax

Practice location:
  • Phone: 910-875-3857
  • Fax:
Mailing address:
  • Phone: 910-875-3857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LILLY MARIE SHORTER
Title or Position: VICE PRESIDENT
Credential:
Phone: 910-875-3857