Healthcare Provider Details

I. General information

NPI: 1629792585
Provider Name (Legal Business Name): SHEPHERD HEALTH AND LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 SOUTHWESTERN RUN UNIT A
YOUNGSTOWN OH
44514-4688
US

IV. Provider business mailing address

670 W BITNER RD UNIT H204
PARK CITY UT
84098-5030
US

V. Phone/Fax

Practice location:
  • Phone: 801-390-1542
  • Fax:
Mailing address:
  • Phone: 801-390-1542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHASE VANCE
Title or Position: OWNER
Credential:
Phone: 801-390-1542