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General NPI Number Information
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NPI Number | 1235283151
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD HOSPICE, INC.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 3470 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-1946
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Country | US
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Telephone | 863-682-0027
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Fax | 863-682-3006
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Provider Business Mailing Address
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Address Line | 12470 TELECOM DR STE 300W ATTENTION: COMPLIANCE
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637-0904
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Country | US
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Telephone | 813-871-8400
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Fax | 813-871-8402
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Authorized Official
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Title or Position | VP, LEGAL SERVICES
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Name | CRYSTAL BUCCIARELLI
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Credential |
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Telephone | 813-871-8075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 50060951
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License Number State | FL
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