Healthcare Provider Details

I. General information

NPI: 1023203429
Provider Name (Legal Business Name): THE GOOD SHEPHERD HOME HEALTH CARE AND HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2007
Last Update Date: 09/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 WILSON AVE
BRISTOL PA
19007-4430
US

IV. Provider business mailing address

2215 WILSON AVE
BRISTOL PA
19007-4430
US

V. Phone/Fax

Practice location:
  • Phone: 215-785-2342
  • Fax: 215-785-2356
Mailing address:
  • Phone: 215-785-2342
  • Fax: 215-785-2356

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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARYANN RICCIO
Title or Position: LPN/OWNER
Credential:
Phone: 215-785-2342