Healthcare Provider Details

I. General information

NPI: 1114315447
Provider Name (Legal Business Name): SHORE HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23379 COMMERCE DR
ACCOMAC VA
23301-1314
US

IV. Provider business mailing address

608 DENBIGH BOULEVARD SUITE 800
NEWPORT NEWS VA
23608-4487
US

V. Phone/Fax

Practice location:
  • Phone: 757-789-5000
  • Fax: 757-789-3556
Mailing address:
  • Phone: 757-875-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WALTER W AUSTIN JR.
Title or Position: EXECUTIVE VP/CFO
Credential:
Phone: 757-875-7545