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General NPI Number Information
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NPI Number | 1841470986
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD FAMILY CARE HOME, LLC
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 12/30/2008
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Provider Practice Location Address
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Address Line | 2810 FLEMING ROAD
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City | GREENSBORO
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State | NC
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Zip | 27410
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Country | US
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Telephone | 336-644-0752
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Fax | 336-643-9731
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Provider Business Mailing Address
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Address Line | 3592 HANCOCK DR
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City | GREENSBORO
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State | NC
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Zip | 27410-9157
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Country | US
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Telephone | 336-644-0752
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Fax | 336-643-9731
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. ARLENE TOMAS BALASSU-PASCUA
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Credential | BSN, RN
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Telephone | 336-644-0752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | MHL-041-754
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License Number State | NC
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