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General NPI Number Information
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NPI Number | 1194318626
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD HOME CARE LLC
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 4148 E HALE CIR
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City | MESA
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State | AZ
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Zip | 85205-4035
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Country | US
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Telephone | 702-712-9359
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Fax |
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Provider Business Mailing Address
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Address Line | 4148 E HALE CIR
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City | MESA
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State | AZ
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Zip | 85205-4035
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EARLNSHA L SHEPHERD
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Credential |
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Telephone | 702-712-9359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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