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General NPI Number Information
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NPI Number | 1972143709
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Entity Type | Organization
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Legal Business Name | THE SHEPHERD'S HOUSE A RECOVERY PROGRAM
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 1650 8TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25703-1702
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Country | US
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Telephone | 304-697-3007
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2521
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City | HUNTINGTON
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State | WV
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Zip | 25726-2521
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Country | US
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Telephone | 304-521-3226
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Fax | 304-523-0932
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ANTHONY JAMES STRADWICK SR.
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Credential |
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Telephone | 304-840-3457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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