MEDICARE: THE SHEPARD'S HOUSE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	6601534	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194807677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SHEPARD'S HOUSE, LLC

Provider Business Mailing Address
First Line	:	6612 E WT HARRIS BLVD
Second Line	:	SUITE I
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-5134
Country	:	US
Telephone Number	:	704-494-8712
Fax Number	:	704-494-8713

Provider Business Practice Location Address
First Line	:	6612 E WT HARRIS BLVD
Second Line	:	SUITE I
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-5134
Country	:	US
Telephone Number	:	704-494-8712
Fax Number	:	704-494-8713

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	MR. DARYLE BATTLE
Credential	:
Telephone Number	:	704-494-8712

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/05/2011

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Directions to “THE SHEPARD'S HOUSE, LLC ” Practice Location

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