1861858532 NPI number — R. J SHEPHERD II, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861858532 NPI number — R. J SHEPHERD II, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R. J SHEPHERD II, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BETTER HOME HEALTH CARE OF GA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861858532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 DRESDEN DR NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKHAVEN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30319-3454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-547-0495
Provider Business Mailing Address Fax Number:
678-547-0496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 228
Provider Business Practice Location Address City Name:
LAGRANGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30240-3225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-547-0495
Provider Business Practice Location Address Fax Number:
678-547-0496
Provider Enumeration Date:
01/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
REGINONAL DIRECTOR
Authorized Official Telephone Number:
678-547-0495

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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