MEDICARE: GOOD SHEPHERD REHABILITATION INSTITUTE INC

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	0815	NV

General Provider Information

NPI Number	:	1437305679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD REHABILITATION INSTITUTE INC

Provider Business Mailing Address
First Line	:	PO BOX 26299
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89126-0299
Country	:	US
Telephone Number	:	702-893-3333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 S BUFFALO DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2749
Country	:	US
Telephone Number	:	702-893-3333
Fax Number	:

Authorized Official
Title or Position	:	OTR/L
Name	:	CHERRY DIZON
Credential	:
Telephone Number	:	702-893-3333

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	08/07/2008

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