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General NPI Number Information
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NPI Number | 1003924283
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Entity Type | Organization
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Legal Business Name | SHIRLEY HARDEN MERRITT
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 122 RIDGEWAY DR
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City | MONROE
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State | GA
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Zip | 30655-5276
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Country | US
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Telephone | 770-207-5426
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 703
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City | MONROE
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State | GA
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Zip | 30655-0703
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Country | US
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Telephone | 770-207-5426
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MRS. SHIRLEY HARDEN MERRITT
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Credential | CNA
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Telephone | 770-207-5426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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