MEDICARE: GOOD SHEPHERD HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1194318626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD HOME CARE LLC

Provider Business Mailing Address
First Line	:	4148 E HALE CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85205-4035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4148 E HALE CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85205-4035
Country	:	US
Telephone Number	:	702-712-9359
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EARLNSHA L SHEPHERD
Credential	:
Telephone Number	:	702-712-9359

Provider Enumeration Date	:	02/16/2021
Last Update Date	:	02/16/2021

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Directions to “GOOD SHEPHERD HOME CARE LLC ” Practice Location

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