Provider Demographics
NPI:1841528544
Name:SHEILAS FAMILY HOME CARE AGENCY
Entity type:Organization
Organization Name:SHEILAS FAMILY HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-964-0573
Mailing Address - Street 1:656 BRANDERMILL RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-7125
Mailing Address - Country:US
Mailing Address - Phone:910-964-0573
Mailing Address - Fax:
Practice Address - Street 1:656 BRANDERMILL RD UNIT 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-7125
Practice Address - Country:US
Practice Address - Phone:910-964-0573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care