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General NPI Number Information
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NPI Number | 1134368459
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Entity Type | Organization
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Legal Business Name | FRIENDS OF GOOD SHEPHERD MANOR
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Dates
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Enumeration Date | 02/10/2009
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Last Update Date | 02/10/2009
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Provider Practice Location Address
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Address Line | 374 GOOD MANOR RD
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City | LUCASVILLE
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State | OH
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Zip | 45648
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Country | US
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Telephone | 740-289-2861
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Fax | 740-289-4355
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Provider Business Mailing Address
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Address Line | 374 GOOD MANOR RD PO BOX 1029
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City | LUCASVILLE
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State | OH
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Zip | 45648
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Country | US
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Telephone | 740-289-2861
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Fax | 740-289-4355
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JACKIE BOWLING
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Credential |
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Telephone | 740-289-2861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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