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NPI Code Detail

MEDICARE: SHIELD ROOFING & CONSTRUCTION, LLC

MEDICARE: SHIELD ROOFING & CONSTRUCTION, 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
1171WH0202XHome Modifications Contractor

General Provider Information

NPI Number : 1366905788
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHIELD ROOFING & CONSTRUCTION, LLC
Provider Business Mailing Address
First Line : 206 4TH ST E
Second Line :
City : SOUTH POINT
State : OH
Zip : 45680-9430
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 206 4TH ST E
Second Line :
City : SOUTH POINT
State : OH
Zip : 45680-9430
Country : US
Telephone Number : 740-861-0286
Fax Number :
Authorized Official
Title or Position : ACCOUNTING MANAGER
Name : REMA HILAL
Credential :
Telephone Number : 740-861-0286
Provider Enumeration Date : 04/11/2019
Last Update Date : 04/11/2019

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Directions to “SHIELD ROOFING & CONSTRUCTION, LLC ” Practice Location

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