Provider Demographics
NPI:1235930868
Name:SHORE CRISIS MANAGEMENT LLC
Entity type:Organization
Organization Name:SHORE CRISIS MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYRIN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-847-9272
Mailing Address - Street 1:227 W 4TH ST STE LL102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-1545
Mailing Address - Country:US
Mailing Address - Phone:336-847-9272
Mailing Address - Fax:
Practice Address - Street 1:227 W 4TH ST STE LL102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1545
Practice Address - Country:US
Practice Address - Phone:336-847-9272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health