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NPI Code Detail

MEDICARE: GOOD SHEPHERD HEALTHCARE LLC

MEDICARE: GOOD SHEPHERD HEALTHCARE 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
1251E00000XHome Health Agency1010661IL

General Provider Information

NPI Number : 1336278761
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOOD SHEPHERD HEALTHCARE LLC
Provider Business Mailing Address
First Line : 3144 W MONTROSE AVE
Second Line : 2ND FLOOR
City : CHICAGO
State : IL
Zip : 60618-1333
Country : US
Telephone Number : 773-478-1784
Fax Number : 773-478-2133
Provider Business Practice Location Address
First Line : 3144 W MONTROSE AVE
Second Line : 2ND FLOOR
City : CHICAGO
State : IL
Zip : 60618-1333
Country : US
Telephone Number : 773-478-1784
Fax Number : 773-478-2133
Authorized Official
Title or Position : ADMINISTRATOR
Name : MICHAEL MANUEL
Credential :
Telephone Number : 773-478-1784
Provider Enumeration Date : 03/02/2007
Last Update Date : 02/06/2023

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Directions to “GOOD SHEPHERD HEALTHCARE LLC ” Practice Location

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