Healthcare Provider Details

I. General information

NPI: 1548264088
Provider Name (Legal Business Name): GOOD SHEPHERD HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BI-COUNTY BLVD. STE. 114
FARMINGDALE NY
11735
US

IV. Provider business mailing address

110 BI-COUNTY BLVD. STE. 114
FARMINGDALE NY
11735
US

V. Phone/Fax

Practice location:
  • Phone: 631-828-7400
  • Fax: 631-828-7494
Mailing address:
  • Phone: 631-828-7400
  • Fax: 631-828-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number251G00000X
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number5151501F
License Number StateNY

VIII. Authorized Official

Name: CAROLYNN OCONNOR
Title or Position: DIRECTOR
Credential:
Phone: 631-828-7400