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General NPI Number Information
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NPI Number | 1902011711
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Entity Type | Organization
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Legal Business Name | RJ SHEPHERD INC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1207 WALTER REED RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4437
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Country | US
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Telephone | 910-424-2929
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Fax | 910-424-2967
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Provider Business Mailing Address
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Address Line | 1207 WALTER REED RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4437
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Country | US
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Telephone | 910-424-2929
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Fax | 910-424-2967
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Authorized Official
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Title or Position | CEO
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Name | MRS. TERESA RENEE OWENS
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Credential | BS
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Telephone | 910-424-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | HC3029
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License Number State | NC
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