Healthcare Provider Details

I. General information

NPI: 1518032028
Provider Name (Legal Business Name): GOOD SHEPHERD GERIATRIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 2ND ST NE
MASON CITY IA
50401-3412
US

IV. Provider business mailing address

302 2ND ST NE
MASON CITY IA
50401-3412
US

V. Phone/Fax

Practice location:
  • Phone: 641-424-1740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ANNE DEMARIS
Title or Position: BKPR
Credential:
Phone: 641-424-1740