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General NPI Number Information
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NPI Number | 1629588728
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD HOUSE, INC
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 728 OLD BUCKROE RD
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City | HAMPTON
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State | VA
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Zip | 23663-1533
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Country | US
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Telephone | 800-557-1722
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Fax |
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Provider Business Mailing Address
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Address Line | 129 PEBBLE BEACH LN
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5958
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Country | US
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Telephone | 757-344-7261
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Fax | 757-818-8619
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Authorized Official
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Title or Position | DIRECTOR
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Name | JANICE ROLLINS
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Credential |
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Telephone | 800-557-1722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 2668
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License Number State | VA
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