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General NPI Number Information
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NPI Number | 1649605437
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD IN-HOME SENIOR CARE
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 1801 FOREST HILLS BLVD 133
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City | BELLA VISTA
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State | AR
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Zip | 72715-3016
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Country | US
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Telephone | 479-248-1475
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Fax | 479-203-7289
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Provider Business Mailing Address
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Address Line | 1801 FOREST HILLS BLVD 133
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City | BELLA VISTA
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State | AR
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Zip | 72715-3016
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Country | US
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Telephone | 479-248-1475
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Fax | 479-203-7289
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Authorized Official
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Title or Position | OWNER
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Name | CHIP A BROWN
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Credential |
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Telephone | 479-248-1475
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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 | 811006810
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License Number State | AR
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