Healthcare Provider Details

I. General information

NPI: 1740022763
Provider Name (Legal Business Name): GOOD SHEPHERD HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 WESTMINSTER ST STE 304
PROVIDENCE RI
02903-4082
US

IV. Provider business mailing address

765 WESTMINSTER ST STE 304
PROVIDENCE RI
02903-4082
US

V. Phone/Fax

Practice location:
  • Phone: 401-409-2928
  • Fax: 401-409-2941
Mailing address:
  • Phone: 401-409-2928
  • Fax: 401-409-2941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANA LOPEZ
Title or Position: CEO & NON-NURSE ADMINISTRATOR
Credential:
Phone: 401-409-2928