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General NPI Number Information
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NPI Number | 1477867802
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Entity Type | Organization
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Legal Business Name | SHIPMAN-FAYETTEVILLE
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 930 CAMBRIDGE ST STE 200
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-9625
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Country | US
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Telephone | 910-321-1047
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Fax | 910-321-1049
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Provider Business Mailing Address
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Address Line | 1614 E MARKET ST
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City | GREENSBORO
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State | NC
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Zip | 27401-3210
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Country | US
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Telephone | 336-272-7919
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Fax | 336-272-0612
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. GLADYS F SHIPMAN
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Credential |
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Telephone | 336-272-7545
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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 | HC4145
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License Number State | NC
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