MEDICARE: SHEPHERDS SENIOR/DISABLED HOME SOLUTIONS

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1639859762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEPHERDS SENIOR/DISABLED HOME SOLUTIONS

Provider Business Mailing Address
First Line	:	18439 SHANNA DR
Second Line	:
City	:	ACCOKEEK
State	:	MD
Zip	:	20607-3209
Country	:	US
Telephone Number	:	443-992-0341
Fax Number	:

Provider Business Practice Location Address
First Line	:	5021 EMO ST
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-2861
Country	:	US
Telephone Number	:	202-568-0792
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	RODNEY VAUGHN
Credential	:
Telephone Number	:	443-992-0341

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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