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General NPI Number Information
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NPI Number | 1336278761
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD HEALTHCARE LLC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 3144 W MONTROSE AVE 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60618-1333
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Country | US
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Telephone | 773-478-1784
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Fax | 773-478-2133
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Provider Business Mailing Address
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Address Line | 3144 W MONTROSE AVE 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60618-1333
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Country | US
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Telephone | 773-478-1784
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Fax | 773-478-2133
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICHAEL MANUEL
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Credential |
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Telephone | 773-478-1784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1010661
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License Number State | IL
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