MEDICARE: THE GOODSHEPHERD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1316399017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GOODSHEPHERD INC

Provider Business Mailing Address
First Line	:	2133 W MORSE AVE
Second Line	:	SUITE 2
City	:	CHICAGO
State	:	IL
Zip	:	60645-4914
Country	:	US
Telephone Number	:	773-220-8384
Fax Number	:

Provider Business Practice Location Address
First Line	:	2133 W MORSE AVE
Second Line	:	SUITE 2
City	:	CHICAGO
State	:	IL
Zip	:	60645-4914
Country	:	US
Telephone Number	:	773-220-8384
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IBILOLA F BISIRIYU
Credential	:
Telephone Number	:	773-220-8384

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	07/06/2016

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Directions to “THE GOODSHEPHERD INC ” Practice Location

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