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General NPI Number Information
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NPI Number | 1114255452
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Entity Type | Organization
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Legal Business Name | THE SHEPHERDS MISSION INC
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 2303 S HOLDEN RD APT 103K
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City | GREENSBORO
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State | NC
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Zip | 27407-5953
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Country | US
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Telephone | 336-772-2697
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 254
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City | REIDSVILLE
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State | NC
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Zip | 27323-0254
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Country | US
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Telephone | 336-772-2697
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MRS. JANIQUE WASHINGTON SMALLS
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Credential | MS
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Telephone | 336-772-2697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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