=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013394048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHORE HOME CARE AGENCY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2015
-----------------------------------------------------
Last Update Date | 04/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 N PROVIDENCE RD
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-5221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-323-1731
-----------------------------------------------------
Fax | 804-323-1209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 N PROVIDENCE RD
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-5221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-323-1731
-----------------------------------------------------
Fax | 804-323-1209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MONICA MCMILLAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-323-1731
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO151157
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO 151092
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------