Provider Demographics
NPI:1124990064
Name:SHEPHERD HOME CARE LLC
Entity type:Organization
Organization Name:SHEPHERD HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIVYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, CNML
Authorized Official - Phone:325-213-4116
Mailing Address - Street 1:2035 KENSINGTON CT SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-7800
Mailing Address - Country:US
Mailing Address - Phone:325-213-4116
Mailing Address - Fax:
Practice Address - Street 1:2035 KENSINGTON CT SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-7800
Practice Address - Country:US
Practice Address - Phone:325-213-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-20
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care