Healthcare Provider Details

I. General information

NPI: 1770117616
Provider Name (Legal Business Name): GOOD SHEPHERD PCA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2020
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 E FLAMINGO RD. SUITE #170
LAS VEGAS NV
89119-5186
US

IV. Provider business mailing address

2235 E FLAMINGO RD. SUITE #170
LAS VEGAS NV
89119-5186
US

V. Phone/Fax

Practice location:
  • Phone: 702-966-7118
  • Fax: 702-839-0095
Mailing address:
  • Phone: 702-966-7118
  • Fax: 702-839-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN ARCEO GALLEGOS JR.
Title or Position: PCA MANAGER
Credential:
Phone: 702-966-7118