Healthcare Provider Details

I. General information

NPI: 1205906864
Provider Name (Legal Business Name): SHORE HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9507 HOSPITAL AVE
NASSAWADOX VA
23413
US

IV. Provider business mailing address

PO BOX 17 9507 HOSPITAL AVE
NASSAWADOX VA
23413
US

V. Phone/Fax

Practice location:
  • Phone: 757-414-8702
  • Fax: 757-414-8335
Mailing address:
  • Phone: 757-414-8702
  • Fax: 757-414-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. ROBERT P YEARTY
Title or Position: CFO
Credential:
Phone: 757-414-8756