Healthcare Provider Details

I. General information

NPI: 1942508304
Provider Name (Legal Business Name): GOOD SHEPERD REBILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 W WASHINGTON AVE STE. 185
LAS VEGAS NV
89128-4337
US

IV. Provider business mailing address

7455 W WASHINGTON AVE STE. 185
LAS VEGAS NV
89128-4337
US

V. Phone/Fax

Practice location:
  • Phone: 702-722-6408
  • Fax: 702-722-6458
Mailing address:
  • Phone: 702-722-6408
  • Fax: 702-722-6458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateNV

VIII. Authorized Official

Name: ROY DE GUZMAN
Title or Position: ADMINISTRATOR
Credential: PT
Phone: 702-722-6408