Provider Demographics
NPI:1306271002
Name:SHEPHERDS CARE SERVICES LLC
Entity type:Organization
Organization Name:SHEPHERDS CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-614-2732
Mailing Address - Street 1:9648 OLIVE BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3002
Mailing Address - Country:US
Mailing Address - Phone:314-884-8786
Mailing Address - Fax:314-667-3193
Practice Address - Street 1:7060 NATURAL BRIDGE RD
Practice Address - Street 2:SUITE #3
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-5105
Practice Address - Country:US
Practice Address - Phone:314-884-8786
Practice Address - Fax:314-667-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care