=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518372424
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHORE HELP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2014
-----------------------------------------------------
Last Update Date | 06/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6601 VENTNOR AVE SUITE 16 - TROY AVE BLDG
-----------------------------------------------------
City | VENTNOR CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08406-2167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-823-1718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6601 VENTNOR AVE SUITE 16 - TROY AVE BLDG
-----------------------------------------------------
City | VENTNOR CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08406-2167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DREW B KLAITS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-823-1718
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HP0059700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | HP0059700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------