Healthcare Provider Details

I. General information

NPI: 1588157630
Provider Name (Legal Business Name): GOOD SHEPARD STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 DODD ST STE A
BLOOMFIELD NJ
07003-4640
US

IV. Provider business mailing address

44 DODD ST STE A
BLOOMFIELD NJ
07003-4640
US

V. Phone/Fax

Practice location:
  • Phone: 973-259-3800
  • Fax: 973-259-3871
Mailing address:
  • Phone: 973-259-3800
  • Fax: 973-259-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. YVONNE W CORT
Title or Position: PRESIDENT
Credential: NURSE
Phone: 862-224-0127