MEDICARE: GOOD SHEPHERD HOSPICE

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	251G00000X	Community Based Hospice Care Agency	251G00000X	NY
2	251G00000X	Community Based Hospice Care Agency	5151501F	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548264088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD HOSPICE

Provider Business Mailing Address
First Line	:	110 BI-COUNTY BLVD.
Second Line	:	STE. 114
City	:	FARMINGDALE
State	:	NY
Zip	:	11735
Country	:	US
Telephone Number	:	631-828-7400
Fax Number	:	631-828-7494

Provider Business Practice Location Address
First Line	:	110 BI-COUNTY BLVD.
Second Line	:	STE. 114
City	:	FARMINGDALE
State	:	NY
Zip	:	11735
Country	:	US
Telephone Number	:	631-828-7400
Fax Number	:	631-828-7494

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CAROLYNN OCONNOR
Credential	:
Telephone Number	:	631-828-7400

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	09/28/2023

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Directions to “GOOD SHEPHERD HOSPICE ” Practice Location

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