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General NPI Number Information
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NPI Number | 1306742549
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD MANAGEMENT CORPORATION
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Dates
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Enumeration Date | 10/15/2026
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Last Update Date | 10/15/2026
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Provider Practice Location Address
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Address Line | 201 SHEPHERD AVE
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City | BROOKLYN
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State | NY
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Zip | 11208-1233
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Country | US
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Telephone | 954-263-3528
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Fax |
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Provider Business Mailing Address
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Address Line | 201 SHEPHERD AVE
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City | BROOKLYN
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State | NY
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Zip | 11208-1233
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Country | US
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Telephone | 954-263-3528
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. GWENDOLYN N DAVIS
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Credential |
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Telephone | 954-236-6528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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