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General NPI Number Information
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NPI Number | 1437305679
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD REHABILITATION INSTITUTE INC
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 2451 S BUFFALO DR STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89117-2749
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Country | US
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Telephone | 702-893-3333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26299
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City | LAS VEGAS
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State | NV
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Zip | 89126-0299
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Country | US
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Telephone | 702-893-3333
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Fax |
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Authorized Official
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Title or Position | OTR/L
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Name | CHERRY DIZON
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Credential |
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Telephone | 702-893-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0815
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License Number State | NV
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