{
"Npi": {
"NPI": "1306742549",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "IS 43 CONSULTING CORPORATION",
"ParentOrgTIN": null,
"OrgName": "GOOD SHEPHERD MANAGEMENT CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "201 SHEPHERD AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROOKLYN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11208-1233",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-263-3528",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "201 SHEPHERD AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BROOKLYN",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11208-1233",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-263-3528",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/15/2026",
"LastUpdateDate": "10/15/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAVIS",
"AuthorizedOfficialFirstName": "GWENDOLYN",
"AuthorizedOfficialMiddleName": "N",
"AuthorizedOfficialTitle": "PRINCIPAL",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "954-236-6528",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QR0800X",
"TaxonomyName": "Recovery Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3104A0625X",
"TaxonomyName": "Assisted Living Facility (Mental Illness)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "324500000X",
"TaxonomyName": "Substance Abuse Rehabilitation Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}