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General NPI Number Information
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NPI Number | 1508257148
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD ASSISTANT LIVING
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 703 N HOUSTON AVE
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City | LIVINGSTON
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State | TX
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Zip | 77351-2933
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Country | US
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Telephone | 936-327-9956
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Fax |
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Provider Business Mailing Address
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Address Line | 703 N HOUSTON AVE
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City | LIVINGSTON
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State | TX
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Zip | 77351-2933
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Country | US
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Telephone | 936-327-9956
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DINA DICKERSON
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Credential |
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Telephone | 936-223-1858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 139482
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License Number State | TX
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