MEDICARE: GOOD SHEPHERD SCHOOL FOR CHILDREN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332BC3200X	Customized Equipment (DME)
2	335E00000X	Prosthetic/Orthotic Supplier
3	261QD1600X	Developmental Disabilities Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39420	OTHER	MO	GROUP HEALTH PLAN
2	39420	OTHER	MO	CARE MANAGEMENT RESOURCES
3	131233	OTHER	MO	BLUE CROSS BLUE SHIELD
4	39420	OTHER	MO	CARPENTERS HEALTH AND WEL
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730225590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD SCHOOL FOR CHILDREN

Provider Business Mailing Address
First Line	:	1170 TIMBER RUN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4482
Country	:	US
Telephone Number	:	314-469-0606
Fax Number	:	314-469-3294

Provider Business Practice Location Address
First Line	:	1170 TIMBER RUN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4482
Country	:	US
Telephone Number	:	314-469-0606
Fax Number	:	314-469-3294

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. ELIZABETH A. ROSE
Credential	:	M.S.W. LCSW
Telephone Number	:	314-469-0606

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	10/06/2010

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Directions to “GOOD SHEPHERD SCHOOL FOR CHILDREN ” Practice Location

Language	Start Address	Practice Location

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