Healthcare Provider Details

I. General information

NPI: 1487688719
Provider Name (Legal Business Name): GOOD SHEPHERD HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 W WASHINGTON AVE STE.115
LAS VEGAS NV
89128-4337
US

IV. Provider business mailing address

11259 E VIA LINDA # 100-997
SCOTTSDALE AZ
85259-4076
US

V. Phone/Fax

Practice location:
  • Phone: 702-893-3333
  • Fax:
Mailing address:
  • Phone: 702-893-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNV

VIII. Authorized Official

Name: ROY MYERS
Title or Position: CHAIRMAN
Credential:
Phone: 480-650-3766