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General NPI Number Information
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NPI Number | 1275704546
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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 | 03/14/2008
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Last Update Date | 02/04/2009
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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 | 187-788-5286
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Fax |
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Provider Business Mailing Address
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Address Line | 374 GOOD MANOR ROAD
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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 |
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Fax |
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Authorized Official
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Title or Position | INTERIM CHIEF EXECUTIVE DIRECTOR
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Name | MR. DAVE PHIPPS
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Credential |
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Telephone | 877-885-2861
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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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