MEDICARE: SHIPMAN-RALEIGH

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	HC4143	NC

General Provider Information

NPI Number	:	1679887061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIPMAN-RALEIGH

Provider Business Mailing Address
First Line	:	1614 E MARKET ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-3210
Country	:	US
Telephone Number	:	336-272-7919
Fax Number	:	336-272-0612

Provider Business Practice Location Address
First Line	:	8366 SIX FORKS RD
Second Line	:	SUITE 102
City	:	RALEIGH
State	:	NC
Zip	:	27615-5074
Country	:	US
Telephone Number	:	919-870-0903
Fax Number	:	919-870-0930

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. GLADYS F SHIPMAN
Credential	:
Telephone Number	:	336-272-7545

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	07/28/2010

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